FDA Adverse Event Injury Summary report: N

CONCERTO CRT-D DR

MDR report key: 1864736 · Received October 12, 2010

Report

Report Number
6000144-2010-05250
Event Type
Injury
Date Received
October 12, 2010
Date of Event
August 13, 2010
Manufacturer
MEDTRONIC MED REL, INC.
Product Code
NIK
PMA / PMN Number
P010031/S031
Removal / Correction Number
ASKU
Adverse Event
Yes
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
IL, US
Reporter Occupation
PHYSICIAN

Narratives

Additional Manufacturer Narrative · 1

THE INFORMATION SUBMITTED REFLECTS ALL RELEVANT DATA RECEIVED. IF ADDITIONAL RELEVANT INFORMATION IS RECEIVED, A SUPPLEMENTAL REPORT WILL BE SUBMITTED. CONTINUATION OF EVENT DESCRIPTION: IT WAS FURTHER REPORTED THAT A SAVE-TO-DISK (STD) FILE WAS RETURNED TO ALLOW EVALUATION OF BATTERY STATUS AND WARRANTY REQUEST. THE DEVICE REMAINS IMPLANTED. NO PATIENT COMPLICATIONS HAVE BEEN REPORTED AS A RESULT OF THIS EVENT. (DATE OF DEATH TO NOT APPLICABLE, PATIENT OUTCOME CHECKED HOSPITALIZATION), EVALUATION SUMMARY: (B)(4): THE ACTUAL DEVICE WAS NOT RECEIVED FOR EVALUATION. WE DID RECEIVE PERFORMANCE DATA COLLECTED FROM THE DEVICE AND HAVE ANALYZED THE DATA. ANALYSIS RESULTS REVEALED THAT BATTERY DEPLETION WAS INDICATED (ELECTIVE REPLACEMENT INDICATION - ERI). ERI WAS REACHED ON (B)(6) 2010 AT 2.61 V. ICD LONGEVITY TOOL INDICATES THAT THE DEVICE MET OR EXCEEDED MEAN LONGEVITY BASED ON SETTINGS AVAILABLE IN THE SAVE TO DISK FILE.

Additional Manufacturer Narrative · 1

THE INFORMATION SUBMITTED REFLECTS ALL RELEVANT DATA RECEIVED. IF ADDITIONAL RELEVANT INFORMATION IS RECEIVED, A SUPPLEMENTAL REPORT WILL BE SUBMITTED. ANALYSIS OF THE DEVICE SAVE-TO-DISK (SRD) IS IN PROCESS; THE RESULTS WILL BE FORWARDED WHEN AVAILABLE.

Description of Event or Problem · 1

IT WAS REPORTED THAT THE PATIENT'S DEVICE HAD PREMATURELY REACHED THE RECOMMENDED REPLACEMENT TIME (RRT) AND THAT THE LEFT VENTRICULAR (LV) LEAD HAD HIGH CAPTURE THRESHOLDS REQUIRING THE OUTPUT TO BE PROGRAMMED AT 5.0 VOLTS/1.5 MSEC. IT WAS ALSO REPORTED THAT THE PATIENT HAS A MALIGNANT, METASTATIC MELANOMA OVERLYING THE RIGHT PECTORAL DEVICE IMPLANT SITE. THE PHYSICIAN ELECTED NOT TO REMOVE THE SYSTEM DUE TO THE MALIGNANT MELANOMA AND A POOR PROGNOSIS FOR THE PATIENT. THE SYSTEM WAS TURNED OFF FOR ALL THERAPIES EXCEPT BI-VENTRICULAR PACING WHICH WILL CONTINUE UNTIL THE DEVICE REACHES END OF SERVICE (EOS). A NEW, SINGLE CHAMBER, DEFIBRILLATOR AND RV PACE/SENSE/DEFIBRILLATOR LEAD WERE IMPLANTED ON THE LEFT SIDE TO PROVIDE TACHYCARDIA/DEFIBRILLATION THERAPIES AND BACK-UP VVI PACING FOR WHEN THE OLD SYSTEM REACHES EOS. THERE WERE NO FURTHER PATIENT COMPLICATIONS REPORTED AS A RESULT OF THIS EVENT.

Description of Event or Problem · 1

IT WAS REPORTED THAT THE PATIENT'S DEVICE HAD PREMATURELY REACHED THE RECOMMENDED REPLACEMENT TIME (RRT) AND THAT THE LEFT VENTRICULAR (LV) LEAD HAD HIGH CAPTURE THRESHOLDS REQUIRING THE OUTPUT TO BE PROGRAMMED AT 5.0 VOLTS/1.5 MSEC. IT WAS ALSO REPORTED THAT THE PATIENT HAS A MALIGNANT, METASTATIC MELANOMA OVERLYING THE RIGHT PECTORAL DEVICE IMPLANT SITE. THE PHYSICIAN ELECTED NOT TO REMOVE THE SYSTEM DUE TO THE MALIGNANT MELANOMA AND A POOR PROGNOSIS FOR THE PATIENT. THE SYSTEM WAS TURNED OFF FOR ALL THERAPIES EXCEPT BI-VENTRICULAR PACING WHICH WILL CONTINUE UNTIL THE DEVICE REACHES END OF SERVICE (EOS). A NEW, SINGLE CHAMBER, DEFIBRILLATOR AND RV PACE/SENSE/DEFIBRILLATOR LEAD WERE IMPLANTED ON THE LEFT SIDE TO PROVIDE TACHYCARDIA/DEFIBRILLATION THERAPIES AND BACK-UP VVI PACING FOR WHEN THE OLD SYSTEM REACHES EOS. THERE WERE NO FURTHER PATIENT COMPLICATIONS REPORTED AS A RESULT OF THIS EVENT.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1 CONCERTO CRT-D DR ASKU NIK MEDTRONIC MED REL, INC. C154DWK ASKU

Patients

Seq Age Sex Outcome Treatment
1 61 YR Hospitalization| R