FDA Adverse Event
Malfunction
Summary report: N
TVL ADX
MDR report key: 2902574
·
Received January 8, 2013
Report
- Report Number
- 2017865-2013-00256
- Event Type
- Malfunction
- Date Received
- January 8, 2013
- Date of Event
- November 14, 2012
- 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 PATIENT PRESENTED IN-CLINIC FOR FOLLOW-UP. HIGH IMPEDANCE AND LOSS CAPTURE WERE OBSERVED. LEAD FRACTURE WAS NOTED. PATIENT WAS FEELING UNWELL DUE TO LACK OF PACING. LEAD WAS REPLACED.
Devices
| Seq | Brand | Generic | Product Code | Manufacturer | Model | Lot | UDI-DI |
|---|---|---|---|---|---|---|---|
| 8768 | TVL ADX | DEFIBRILLATION LEAD | NVY | ST JUDE MEDICAL CARDIAC RHYTHM MANAGEMENT DIVISION | 1559/65 | NA |
Patients
| Seq | Age | Sex | Outcome | Treatment |
|---|---|---|---|---|
| 1 | 78 YR |