BEUDAMED
    FDA Adverse Event Injury Summary report: N

    FORTIFY VR

    MDR report key: 3210685 · Received July 8, 2013

    Report

    Report Number
    2938836-2013-03352
    Event Type
    Injury
    Date Received
    July 8, 2013
    Date of Event
    May 7, 2013
    Manufacturer
    ST JUDE MEDICAL CARDIAC RHYTHM MANAGEMENT DIVISION
    Product Code
    LWS
    PMA / PMN Number
    P910023
    Removal / Correction Number
    NA
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    ND
    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 POST-SENSED T-WAVE OVERSENSING WAS OBSERVED. THE PATIENT RECEIVED ATP THERAPY AND HAD BEEN FEELING FATIGUED RECENTLY. PHYSICIAN SUSPECTED ELECTROLYTE IMBALANCE. REPROGRAMMING WAS PERFORMED. THE PATIENT WILL BE MONITORED WITH ROUTINE FOLLOW UP.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    310378 FORTIFY VR IMPLANTABLE CARDIOVERTER DEFIBRILLATOR LWS ST JUDE MEDICAL CARDIAC RHYTHM MANAGEMENT DIVISION CD1231-40 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 70 YR Required Intervention