FDA Adverse Event
Injury
Summary report: N
UNIFY QUADRA CRT-D, DF4 CONNECTOR
MDR report key: 3090018
·
Received May 2, 2013
Report
- Report Number
- 2938836-2013-01235
- Event Type
- Injury
- Date Received
- May 2, 2013
- Date of Event
- February 20, 2013
- Manufacturer
- ST JUDE MEDICAL CARDIAC RHYTHM MANAGEMENT DIVISION
- Product Code
- NIK
- 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 THE REPORTED HIGH PACING LEAD IMPEDANCE WAS CONFIRMED. X-RAY ANALYSIS IDENTIFIED A BROKEN ATRIAL-TIP WIRE AS THE CAUSE OF THE HIGH IMPEDANCE.
Description of Event or Problem · 1
IT WAS REPORTED THAT DURING POST ICD IMPLANT FOLLOW UP, HIGH ATRIAL IMPEDANCE WAS OBSERVED. WHEN THE LEAD WAS TESTED WITH AN ANALYZER AND WITH A NEW DEVICE, IMPEDANCE MEASUREMENTS WERE NORMAL. THE DEVICE WAS EXPLANTED AND REPLACED.
Devices
| Seq | Brand | Generic | Product Code | Manufacturer | Model | Lot | UDI-DI |
|---|---|---|---|---|---|---|---|
| 191445 | UNIFY QUADRA CRT-D, DF4 CONNECTOR | IMPLANTABLE CARDIOVERTER DEFIBRILLATOR | NIK | ST JUDE MEDICAL CARDIAC RHYTHM MANAGEMENT DIVISION | CD3251-40Q | NA |
Patients
| Seq | Age | Sex | Outcome | Treatment |
|---|---|---|---|---|
| 1 | 68 YR | Required Intervention |