BEUDAMED
    FDA Adverse Event Injury Summary report: N

    IDENTITY ADX VDR

    MDR report key: 1223912 · Received November 10, 2008

    Report

    Report Number
    2017865-2008-03396
    Event Type
    Injury
    Date Received
    November 10, 2008
    Date of Event
    July 18, 2008
    Manufacturer
    ST JUDE MEDICAL CARDIAC RHYTHM MANAGEMENT DIVISION
    Product Code
    DXY
    PMA / PMN Number
    NA
    Removal / Correction Number
    NA
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Occupation
    OTHER HEALTH CARE PROFESSIONAL

    Narratives

    Additional Manufacturer Narrative · 1

    ALL INFORMATION PROVIDED BY MANUFACTURER, NO MEDWATCH FORM WAS RECEIVED.

    Description of Event or Problem · 1

    IT WAS REPORTED THAT DEFECTIVE PACING WAS OBSERVED WHICH RESULTED IN THE PATIENT CONVULSING. THE SYSTEM WAS REPLACED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 IDENTITY ADX VDR IMPLANTABLE PACEMAKER PULSE GENERATOR DXY ST JUDE MEDICAL CARDIAC RHYTHM MANAGEMENT DIVISION 5480 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 Required Intervention