BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    ELLIPSE DR

    MDR report key: 3090117 · Received May 2, 2013

    Report

    Report Number
    2938836-2013-01200
    Event Type
    Malfunction
    Date Received
    May 2, 2013
    Date of Event
    January 4, 2013
    Manufacturer
    ST JUDE MEDICAL CARDIAC RHYTHM MANAGEMENT DIVISION
    Product Code
    LWS
    PMA / PMN Number
    P910023
    Removal / Correction Number
    NA
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CA
    Reporter Occupation
    OTHER HEALTH CARE PROFESSIONAL

    Narratives

    Additional Manufacturer Narrative · 1

    ALL INFORMATION PROVIDED BY MANUFACTURER, NO MEDWATCH FORM WAS RECEIVED THE REPORTED FIELD EVENT OF EXTENDED CHARGE TIMES WAS CONFIRMED AFTER REVIEW OF THE DEVICE DIAGNOSTICS DATA. THE CAUSE OF THE EXTENDED CHARGE TIME ANOMALY WAS DUE TO AN ANOMALOUS COMPONENT.

    Description of Event or Problem · 1

    IT WAS REPORTED THAT THE DEVICE REACHED EXTENDED CHARGE TIME WHILE STILL IN THE PACKAGING.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    192162 ELLIPSE DR IMPLANTABLE CARDIOVERTER DEFIBRILLATOR LWS ST JUDE MEDICAL CARDIAC RHYTHM MANAGEMENT DIVISION CD2311-36 NA

    Patients

    Seq Age Sex Outcome Treatment
    1