BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    ATLAS II DR

    MDR report key: 3101273 · Received May 9, 2013

    Report

    Report Number
    2938836-2013-02084
    Event Type
    Malfunction
    Date Received
    May 9, 2013
    Date of Event
    March 24, 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
    OR
    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 DEVICE WAS DOUBLE COUNTING R-WAVES WHICH CAUSED THE PATIENT TO RECEIVE UNANTICIPATED THERAPY. REPROGRAMMING WAS RECOMMENDED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    203239 ATLAS II DR IMPLANTABLE CARDIOVERTER DEFIBRILLATOR LWS ST JUDE MEDICAL CARDIAC RHYTHM MANAGEMENT DIVISION V-265 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 79 YR