BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    ELLIPSE VR, DF4 CONNECTOR

    MDR report key: 3090194 · Received May 2, 2013

    Report

    Report Number
    2938836-2013-01174
    Event Type
    Malfunction
    Date Received
    May 2, 2013
    Date of Event
    February 1, 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
    IN
    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

    AN ASYMPTOMATIC PATIENT PRESENTED IN-CLINIC FOR FOLLOW-UP, AND POST-PACED T-WAVE OVERSENSING WAS OBSERVED. THE PATIENT DID NOT RECEIVED INAPPROPRIATE THERAPY. PROGRAMMING CHANGE WAS SUGGESTED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    191342 ELLIPSE VR, DF4 CONNECTOR IMPLANTABLE CARDIOVERTER DEFIBRILLATOR LWS ST JUDE MEDICAL CARDIAC RHYTHM MANAGEMENT DIVISION CD1311-36Q NA

    Patients

    Seq Age Sex Outcome Treatment
    1 49 YR