BEUDAMED
    FDA Adverse Event Injury Summary report: N

    VERITY DR

    MDR report key: 2983796 · Received February 28, 2013

    Report

    Report Number
    2017865-2013-01597
    Event Type
    Injury
    Date Received
    February 28, 2013
    Date of Event
    December 17, 2012
    Manufacturer
    ST JUDE MEDICAL CARDIAC RHYTHM MANAGEMENT DIVISION
    Product Code
    LWP
    PMA / PMN Number
    NA
    Removal / Correction Number
    NA
    Adverse Event
    Yes
    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. FINAL ANALYSIS FOUND A HYRBID ANOMALY WHICH RESULTED IN THE LOSS OF SENSING.

    Description of Event or Problem · 1

    IT WAS REPORTED THAT THE PULSE GENERATOR EXHIBITED LOSS OF SENSING. THE DEVICE WAS EXPLANTED AND REPLACED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    89053 VERITY DR IMPLANTABLE PACEMAKER PULSE GENERATOR LWP ST JUDE MEDICAL CARDIAC RHYTHM MANAGEMENT DIVISION 5356 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 Required Intervention