FDA Adverse Event Malfunction Summary report: N

CARELINK

MDR report key: 3152466 · Received June 7, 2013

Report

Report Number
2182208-2013-01551
Event Type
Malfunction
Date Received
June 7, 2013
Date of Event
April 25, 2013
Report Date
April 25, 2013
Manufacturer
MEDTRONIC, INC.
Product Code
KRG
PMA / PMN Number
P890003
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
JA
Reporter Occupation
OTHER

Narratives

Additional Manufacturer Narrative · 1

PRODUCT EVENT SUMMARY: ANALYSIS WAS UNABLE TO CONFIRM THE CUSTOMER COMMENT OF TELEMETRY FAILURE, THE PROGRAMMER HEAD PASSED FUNCTIONAL AND SYSTEMS TESTS AND NO OTHER ANOMALIES WERE FOUND. 2090: ANALYSIS CONFIRMED THE CUSTOMER COMMENT OF TELEMETRY FAILURE AND ATTRIBUTED IT TO THE PRINTED CIRCUIT (PC) LINK ELECTRONIC MODULE (LEM) BOARD WHICH WAS THEREFORE REPLACED. CONCOMITANT PRODUCTS: PRODUCT ID 2067 RADIO FREQUENCY PROGRAMMER HEAD; PRODUCT ID 229047 SOFTWARE ANALYZER. (B)(4).

Additional Manufacturer Narrative · 1

THIS EVENT OCCURRED OUTSIDE THE US WHERE THE SAME MODEL IS DISTRIBUTED. ALL INFORMATION PROVIDED IS INCLUDED IN THIS REPORT. PATIENT INFORMATION IS NOT GENERALLY AVAILABLE DUE TO CONFIDENTIALITY CONCERNS. (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 PROGRAMMER HAD "TELEMETRY FAILURE." BOTH THE PROGRAMMER AND THE PROGRAMMER HEAD WERE RETURNED FOR SERVICE. NO PATIENT COMPLICATIONS HAVE BEEN REPORTED AS A RESULT OF THIS EVENT.

Description of Event or Problem · 1

IT WAS REPORTED THAT THE PROGRAMMER HAD "TELEMETRY FAILURE." BOTH THE PROGRAMMER AND THE PROGRAMMER HEAD WERE RETURNED FOR SERVICE. NO PATIENT COMPLICATIONS HAVE BEEN REPORTED AS A RESULT OF THIS EVENT.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
253068 CARELINK PROGRAMMER, PACEMAKER KRG MEDTRONIC, INC. 2090

Patients

Seq Age Sex Outcome Treatment
1