FDA Adverse Event Injury Summary report: N

ATLAS II PLUS DR

MDR report key: 1223427 · Received November 10, 2008

Report

Report Number
2017865-2008-03656
Event Type
Injury
Date Received
November 10, 2008
Date of Event
September 15, 2008
Manufacturer
ST JUDE MEDICAL CARDIAC RHYTHM MANAGEMENT DIVISION
Product Code
LWS
PMA / PMN Number
PMAP910023
Removal / Correction Number
NA
Adverse Event
Yes
Report Source
Manufacturer report
Reporter Location
LA
Reporter Occupation
OTHER HEALTH CARE PROFESSIONAL

Narratives

Additional Manufacturer Narrative · 1

THE REPORTED FIELD EXPERIENCE OF HWVVI MODE WAS CONFIRMED IN THE LABORATORY. UPON INTERROGATION, THE DEVICE WAS FOUND TO BE IN HWVVI MODE. ANALYSIS OF THE RAM MAP REVEALED THAT THE DEVICE HAD GONE INTO HWVVI MODE IN 2008, AFTER DETECTING SEVERAL PARITY ERRORS. AN X-RAY INSPECTION REVEALED NO ANOMALIES. THE CAUSE OF THE PARITY ERRORS COULD NOT BE CONCLUSIVELY DETERMINED.

Description of Event or Problem · 1

IT WAS REPORTED THAT THE DEVICE HAD GONE INTO BVVI MODE. THE DEVICE WAS REPLACED.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1 ATLAS II PLUS DR IMPLANTABLE CARDIOVERTER DEFIBRILLATOR LWS ST JUDE MEDICAL CARDIAC RHYTHM MANAGEMENT DIVISION V-268 NA

Patients

Seq Age Sex Outcome Treatment
1 Required Intervention