FDA Adverse Event Injury Summary report: N

SPRINT QUATTRO

MDR report key: 2812335 · Received October 31, 2012

Report

Report Number
2649622-2012-16437
Event Type
Injury
Date Received
October 31, 2012
Date of Event
August 1, 2012
Manufacturer
MPRI
Product Code
LWS
PMA / PMN Number
P920015/S24
Adverse Event
Yes
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
AZ, US
Reporter Occupation
PHYSICIAN

Narratives

Additional Manufacturer Narrative · 1

PRODUCT EVENT SUMMARY: PRODUCT PERFORMANCE INFORMATION WAS RECEIVED, ANALYZED, AND OVERSENSING WAS NOTED AS ONE VENTRICULAR NON-SUSTAINED TACHYCARDIA EPISODE AT 170MS OCCURRED ON (B)(6) 2012. ADDITIONALLY, INTERFERENCE/NOISE WAS NOTED AS THE VENTRICULAR SHORT INVERVAL COUNT WAS 127445 COUNTS IN 52.64 DAYS BETWEEN (B)(6) 2012.

Additional Manufacturer Narrative · 1

THE INFORMATION SUBMITTED REFLECTS ALL RELEVANT DATA RECEIVED. IF ADDITIONAL RELEVANT INFORMATION IS RECEIVED, A SUPPLEMENTAL REPORT WILL BE SUBMITTED.

Description of Event or Problem · 1

IT WAS REPORTED THAT THE RIGHT VENTRICULAR LEAD HAD OVERSENSING ONE DAY POST IMPLANT WHICH WAS NOT REPRODUCIBLE WITH ISOMETRICS. THE LEAD POLARITY WAS REPROGRAMMED AND THE LEAD REMAINS IN USE. NO PATIENT COMPLICATIONS HAVE BEEN REPORTED AS AS RESULT OF THIS EVENT.

Description of Event or Problem · 1

IT WAS REPORTED THAT THE RIGHT VENTRICULAR LEAD HAD OVERSENSING ONE DAY POST IMPLANT WHICH WAS NOT REPRODUCIBLE WITH ISOMETRICS. THE LEAD POLARITY WAS REPROGRAMMED AND THE LEAD REMAINS IN USE. NO PATIENT COMPLICATIONS HAVE BEEN REPORTED AS AS RESULT OF THIS EVENT.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1 SPRINT QUATTRO DEFIBRILLATOR, AUTOMATIC IMPLANTABLE CARDIOVERTER LWS MPRI 6947

Patients

Seq Age Sex Outcome Treatment
1 67 YR Required Intervention 5076 IMPLANTABLE PACING LEAD| (B)(4) IMPLANTABLE PACEMAKER/CARDIO/DEFIB