FDA Adverse Event
Injury
Summary report: N
UNIFY ASSURA CRT-D
MDR report key: 3210707
·
Received July 8, 2013
Report
- Report Number
- 2938836-2013-03458
- Event Type
- Injury
- Date Received
- July 8, 2013
- Date of Event
- May 17, 2013
- Manufacturer
- ST JUDE MEDICAL CARDIAC RHYTHM MANAGEMENT DIVISION
- Product Code
- NIK
- PMA / PMN Number
- P910023
- Removal / Correction Number
- NA
- Adverse Event
- Yes
- Product Problem
- Yes
- Report Source
- Manufacturer report
- Reporter Location
- WI
- 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 A PATIENT RECEIVED AN ALERT TRANSMISSION FOR NON-SUSTAINED LEAD NOISE. MYOPOTENTIAL SIGNALS WERE BEING SENSED INTERMITTENTLY. REPROGRAMMING OF THE DEVICE WILL BE PERFORMED.
Description of Event or Problem · 1
NEW INFORMATION NOTED THAT THE ASYMPTOMATIC PATIENT PRESENTED IN-CLINIC FOR FOLLOW UP, POST-PACED T-WAVE OVERSENSING WAS OBSERVED. THE PATIENT RECEIVED INAPPROPRIATE ATP. THE DEVICE WAS REPROGRAMMED.
Devices
| Seq | Brand | Generic | Product Code | Manufacturer | Model | Lot | UDI-DI |
|---|---|---|---|---|---|---|---|
| 310756 | UNIFY ASSURA CRT-D | IMPLANTABLE CARDIOVERTER DEFIBRILLATOR | NIK | ST JUDE MEDICAL CARDIAC RHYTHM MANAGEMENT DIVISION | CD3257-40 | NA |
Patients
| Seq | Age | Sex | Outcome | Treatment |
|---|---|---|---|---|
| 1 | 82 YR | Required Intervention |