BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    TVL ADX

    MDR report key: 1895520 · Received November 10, 2010

    Report

    Report Number
    2017865-2010-04237
    Event Type
    Malfunction
    Date Received
    November 10, 2010
    Date of Event
    August 6, 2010
    Manufacturer
    ST JUDE MEDICAL CARDIAC RHYTHM MANAGEMENT DIVISION
    Product Code
    NVY
    PMA / PMN Number
    P950022
    Removal / Correction Number
    NA
    Product Problem
    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 THE PACING LEAD IMPEDANCE HAD DECREASED. NO NOISE, INAPPROPRIATE THERAPIES OR EPISODES WERE NOTED. POSSIBLE INSULATION DAMAGE. NO FURTHER INFORMATION AVAILABLE. THE LEAD REMAINS IMPLANTED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 TVL ADX DEFIBRILLATION LEAD NVY ST JUDE MEDICAL CARDIAC RHYTHM MANAGEMENT DIVISION 1559/65 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 77 YR