FDA Adverse Event Injury Summary report: N

CONSULTA CRT-D

MDR report key: 2813426 · Received October 31, 2012

Report

Report Number
6000094-2012-02456
Event Type
Injury
Date Received
October 31, 2012
Report Date
November 27, 2012
Manufacturer
MEDTRONIC S.A.
Product Code
NIK
Removal / Correction Number
Z-0111-2011
Adverse Event
Yes
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
NL
Reporter Occupation
PHYSICIAN

Narratives

Additional Manufacturer Narrative · 1

THIS EVENT OCCURRED OUTSIDE THE US. ALL INFORMATION PROVIDED IS INCLUDED IN THIS REPORT. IF ADDITIONAL RELEVANT INFORMATION IS RECEIVED, A SUPPLEMENTAL REPORT WILL BE SUBMITTED. PATIENT INFORMATION IS NOT GENERALLY AVAILABLE DUE TO CONFIDENTIALITY CONCERNS. THIS MODEL NUMBER IS NOT APPROVED FOR DISTRIBUTION IN THE UNITED STATES, HOWEVER, IT IS SAME/SIMILAR TO A DEVICE MARKETED IN THE U.S. EVALUATION SUMMARY: (B)(4) - PERFORMANCE DATA FROM THE DEVICE WAS ANALYZED AND REVEALED THAT THE WEEKLY BATTERY VOLTAGE TREND DATA SHOWS MIN BAT=2.974 TO 2.652 VOLTS BETWEEN (B)(4) 2012 AND IS BEFORE DEVICE RECOMMENDED REPLACEMENT, WHICH IS <= 2.651 VOLTS.

Additional Manufacturer Narrative · 1

PRODUCT EVALUATION SUMMARY: THE DEVICE WAS RETURNED, ANALYZED AND ANALYSIS REVEALED THAT THE DEVICE MET 66% OF THE EXPECTED LONGEVITY. (B)(4).

Description of Event or Problem · 1

IT WAS REPORTED THAT THE DEVICE HAD AN UNEXPECTED LONGEVITY AS IT REACHED ITS RECOMMENDED REPLACEMENT TIME (RRT) AFTER 2.5 YEARS OF SERVICE LIFE. THE DEVICE WAS EXPLANTED AND REPLACED. NO PATIENT COMPLICATIONS HAVE BEEN REPORTED AS A RESULT OF THIS EVENT.

Description of Event or Problem · 1

IT WAS REPORTED THAT THE DEVICE HAD AN UNEXPECTED LONGEVITY AS IT REACHED ITS RECOMMENDED REPLACEMENT TIME (RRT) AFTER 2.5 YEARS OF SERVICE LIFE. THE DEVICE WAS EXPLANTED AND REPLACED. NO PATIENT COMPLICATIONS HAVE BEEN REPORTED AS A RESULT OF THIS EVENT.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1 CONSULTA CRT-D IMPLANTABLE PACEMAKER/CARDIO/DEFIB NIK MEDTRONIC S.A. D234TRK

Patients

Seq Age Sex Outcome Treatment
1 48 YR Hospitalization| R