FDA Adverse Event Injury Summary report: N

PROTECTA XT CRT-D

MDR report key: 3151598 · Received June 7, 2013

Report

Report Number
9614453-2013-01091
Event Type
Injury
Date Received
June 7, 2013
Report Date
March 4, 2013
Manufacturer
IPG MFG SWITZERLAND
Product Code
NIK
PMA / PMN Number
P010031
Adverse Event
Yes
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
KY, US
Reporter Occupation
PHYSICIAN

Narratives

Additional Manufacturer Narrative · 1

PRODUCT EVENT SUMMARY: THE DEVICE WAS RETURNED AND ANALYZED. ANALYSIS REVEALED THE RETURNED DEVICE INDICATED NORMAL BATTERY DEPLETION.

Additional Manufacturer Narrative · 1

THE INFORMATION SUBMITTED REFLECTS ALL RELEVANT DATA RECEIVED. IF ADDITIONAL RELEVANT INFORMATION IS RECEIVED, A SUPPLEMENTAL REPORT WILL BE SUBMITTED. CONCOMITANT PRODUCTS: 4076, IMPLANTABLE PACING LEAD, (B)(6) 2011; 4196, IMPLANTABLE PACING LEAD, (B)(6) 2011. (B)(4).

Additional Manufacturer Narrative · 1

IF INFORMATION IS PROVIDED IN THE FUTURE, A SUPPLEMENTAL REPORT WILL BE ISSUED.

Description of Event or Problem · 1

IT WAS REPORTED THAT THE PATIENT RECEIVED SEVERAL INAPPROPRIATE SHOCKS, AND UPON INTERROGATION, THE RIGHT VENTRICULAR (RV) LEAD EXHIBITED EXCESSIVE NOISE OVERSENSING, INCLUDING T-WAVE OVERSENSING (TWOS). A FRACTURE WAS INITIALLY SUSPECTED, AS WELL AS A SETSCREW ISSUE. THE LEAD WAS REPROGRAMMED, AND A REVISION PROCEDURE WAS SCHEDULED. DURING THE REVISION PROCEDURE, THE DEVICE WAS DISCONNECTED FROM THE LEAD, AND A NEW DEVICE WAS CONNECTED TO THE EXISTING LEAD. NO NOISE WAS SEEN UPON CONNECTION TO THE NEW DEVICE, SO AS A RESULT, THE LEAD WAS CONSIDERED TO BE FUNCTIONING APPROPRIATELY, AND THE DEVICE WAS EXPLANTED AND REPLACED. NO FURTHER PATIENT COMPLICATIONS HAVE BEEN REPORTED AS A RESULT OF THIS EVENT.

Description of Event or Problem · 1

IT WAS REPORTED THAT THE PATIENT RECEIVED SEVERAL INAPPROPRIATE SHOCKS, AND UPON INTERROGATION, THE RIGHT VENTRICULAR (RV) LEAD EXHIBITED EXCESSIVE NOISE OVERSENSING, INCLUDING T-WAVE OVERSENSING (TWOS). A FRACTURE WAS INITIALLY SUSPECTED, AS WELL AS A SETSCREW ISSUE. THE LEAD WAS REPROGRAMMED, AND A REVISION PROCEDURE WAS SCHEDULED. DURING THE REVISION PROCEDURE, THE DEVICE WAS DISCONNECTED FROM THE LEAD, AND A NEW DEVICE WAS CONNECTED TO THE EXISTING LEAD. NO NOISE WAS SEEN UPON CONNECTION TO THE NEW DEVICE, SO AS A RESULT, THE LEAD WAS CONSIDERED TO BE FUNCTIONING APPROPRIATELY, AND THE DEVICE WAS EXPLANTED AND REPLACED. NO FURTHER PATIENT COMPLICATIONS HAVE BEEN REPORTED AS A RESULT OF THIS EVENT.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
252138 PROTECTA XT CRT-D DEFIBRILLATOR, AUTOMATIC IMPLANTABLE CARDIOVERTER, WITH CARDIAC RESYNCHRONIZATIO NIK IPG MFG SWITZERLAND D314TRG

Patients

Seq Age Sex Outcome Treatment
1 00070 YR Hospitalization| L| R 6947 IMPLANTABLE TACHY LEAD