BEUDAMED
    FDA Adverse Event Injury Summary report: N

    PROMOTE QUADRA CRT-D, DF4 CONNECTOR

    MDR report key: 2984503 · Received February 28, 2013

    Report

    Report Number
    2938836-2013-00568
    Event Type
    Injury
    Date Received
    February 28, 2013
    Manufacturer
    ST JUDE MEDICAL CARDIAC RHYTHM MANAGEMENT DIVISION
    Product Code
    NIK
    PMA / PMN Number
    NA
    Removal / Correction Number
    NA
    Adverse Event
    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 SYSTEM WAS EXPLANTED DUE TO POCKET INFECTION.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    87860 PROMOTE QUADRA CRT-D, DF4 CONNECTOR IMPLANTABLE CARDIOVERTER DEFIBRILLATOR NIK ST JUDE MEDICAL CARDIAC RHYTHM MANAGEMENT DIVISION CD3239-40Q NA

    Patients

    Seq Age Sex Outcome Treatment
    1 Required Intervention 7121Q,(B)(4)/1999,(B)(4)/1458Q,(B)(4)