BEUDAMED
    FDA Adverse Event Injury Summary report: N

    KAPPA KSR 401

    MDR report key: 16903773 · Received May 10, 2023

    Report

    Report Number
    2182208-2023-01316
    Event Type
    Injury
    Date Received
    May 10, 2023
    Date of Event
    August 27, 2022
    Report Date
    May 10, 2023
    Manufacturer
    MEDTRONIC, INC.
    Product Code
    NVZ
    PMA / PMN Number
    P970012
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    FI
    Reporter Occupation
    PHYSICIAN
    Health Professional
    Yes

    Narratives

    Additional Manufacturer Narrative · 0

    THIS INFORMATION IS BASED ENTIRELY ON JOURNAL LITERATURE. MEDTRONIC WAS MADE AWARE OF THIS EVENT THROUGH A SEARCH OF LITERATURE PUBLICATIONS. THIS EVENT OCCURRED OUTSIDE THE US. PATIENT INFORMATION IS LIMITED DUE TO CONFIDENTIALITY CONCERNS. OF NOTE, MULTIPLE PATIENTS AND MULTIPLE MANUFACTURERS WERE NOTED IN THE ARTICLE; HOWEVER, A ONE-TO-ONE CORRELATION COULD NOT BE MADE WITH UNIQUE PRODUCT SERIAL/LOT NUMBERS. THE BASELINE GENDER/AGE CHARACTERISTICS IS MALE/58 YEARS OLD. THE MODEL LISTED IN THE REPORT IS A REPRESENTATIVE OF THE MODEL FAMILY, AS THERE IS NO SPECIFIC MODEL LISTED. WITHOUT A LOT NUMBER OR DEVICE SERIAL NUMBER, THE MANUFACTURING DATE CANNOT BE DETERMINED. SINCE NO DEVICE ID WAS PROVIDED, IT IS UNKNOWN IF THIS EVENT HAS BEEN PREVIOUSLY REPORTED. A REQUEST FOR ADDITIONAL INFORMATION WILL BE MADE AND UPON RECEIPT A SUPPLEMENTAL REPORT WILL BE SUBMITTED ACCORDINGLY. REFERENCED ARTICLE: REDUCING CARDIAC IMPLANTABLE ELECTRONIC DEVICE¿INDUCED ARTEFACTS IN CARDIAC MAGNETIC RESONANCE IMAGING. EUROPEAN RADIOLOGY. 2023 FEB;33(2):1229-1242. PMID: 36029346 DOI: 10.1007/S00330-022-09059-W MEDTRONIC IS SUBMITTING THIS REPORT TO COMPLY WITH FDA REPORTING REGULATIONS UNDER 21 CFR PARTS 4 AND 803. THIS REPORT IS BASED UPON INFORMATION OBTAINED BY MEDTRONIC, WHICH THE COMPANY MAY NOT HAVE BEEN ABLE TO FULLY INVESTIGATE OR VERIFY PRIOR TO THE DATE THE REPORT WAS REQUIRED BY THE FDA. MEDTRONIC HAS MADE REASONABLE EFFORTS TO OBTAIN MORE COMPLETE INFORMATION AND HAS PROVIDED AS MUCH RELEVANT INFORMATION AS IS AVAILABLE TO THE COMPANY AS OF THE SUBMISSION DATE OF THIS REPORT. THIS REPORT DOES NOT CONSTITUTE AN ADMISSION OR A CONCLUSION BY FDA, MEDTRONIC, OR ITS EMPLOYEES THAT THE DEVICE, MEDTRONIC, OR ITS EMPLOYEE CAUSED OR CONTRIBUTED TO THE EVENT DESCRIBED IN THE REPORT. IN PARTICULAR, THIS REPORT DOES NOT CONSTITUTE AN ADMISSION BY ANYONE THAT THE PRODUCT DESCRIBED IN THIS REPORT HAS ANY ¿DEFECTS¿ OR HAS ¿MALFUNCTIONED¿. THESE WORDS ARE INCLUDED IN THE FDA 3500A FORM AND ARE FIXED ITEMS FOR SELECTION CREATED BY THE FDA TO CATEGORIZE THE TYPE OF EVENT SOLELY FOR THE PURPOSE OF REGULATORY REPORTING. MEDTRONIC OBJECTS TO THE USE OF THESE WORDS AND OTHERS LIKE THEM BECAUSE OF THE LACK OF DEFINITION AND THE CONNOTATIONS IMPLIED BY THESE TERMS. THIS STATEMENT SHOULD BE INCLUDED WITH ANY INFORMATION OR REPORT DISCLOSED TO THE PUBLIC UNDER THE FREEDOM OF INFORMATION ACT.

    Description of Event or Problem · 0

    LITERATURE WAS REVIEWED REGARDING MAGNETIC RESONANCE IMAGING (MRI) IN CARDIOVASCULAR IMPLANTABLE ELECTRONIC DEVICES (CIEDS). THE AUTHORS DESCRIBED TWO COMPLICATIONS. ONE PACEMAKER DEPENDENT PATIENT¿S IMPLANTABLE PULSE GENERATOR (IPG) WAS PROGRAMMED TO ASYNCHRONOUS PACING MODE (DOO) BEFORE THE MRI. HOWEVER, DURING THE MRI, IT REACHED THE ELECTIVE REPLACEMENT INDICATOR (ERI) MODE DUE TO TEMPORARILY PROGRAMMED HIGH OUTPUT VOLTAGE, WHICH LED TO AN INHIBITED PACING MODE (VVI). AFTER THE MRI, THE IPG WAS REPROGRAMMED, AND ITS FUNCTION REVERTED TO NORMAL. THERE WAS ALSO A RIGHT VENTRICULAR (RV) LEAD WHICH EXHIBITED AN ELEVATED PACING THRESHOLD FOLLOWING THE MRI. THE LEAD WAS REPROGRAMMED. THE STATUS OF THE DEVICE AND LEAD IS UNKNOWN. NO ADVERSE PATIENT EFFECTS OR ADDITIONAL PRODUCT PERFORMANCE ISSUES WERE REPORTED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    687757 KAPPA KSR 401 PULSE GENERATOR, PERMANENT, IMPLANTABLE NVZ MEDTRONIC, INC. KSR401

    Patients

    Seq Age Sex Outcome Treatment
    1 58 YR Unknown Required Intervention UNKNOWN COMPETITOR LEAD