FDA Adverse Event Malfunction Summary report: N

QUADRA ASSURA CRT-D, DF4 CONNECTOR

MDR report key: 3210711 · Received July 8, 2013

Report

Report Number
2938836-2013-03502
Event Type
Malfunction
Date Received
July 8, 2013
Date of Event
April 14, 2013
Manufacturer
ST JUDE MEDICAL CARDIAC RHYTHM MANAGEMENT DIVISION
Product Code
NIK
PMA / PMN Number
P910023
Removal / Correction Number
NA
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
PA
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-PACED T-WAVE OVERSENSING WAS OBSERVED ON AN ASYMPTOMATIC PATIENT VIA A MERLIN.NET TRANSMISSION. THE OVERSENSING WAS NOTED ON A STORED EGM. DEVICE WAS REPROGRAMMED.

Description of Event or Problem · 1

NEW INFORMATION RECEIVED STATES THAT THE PRIOR RECOMMENDED PROGRAMMING CHANGES WERE MADE. SUBSEQUENTLY, NON-SUSTAINED LEAD NOISE DUE TO POST-PACED T WAVE OVERSENSING WAS OBSERVED. THE PATIENT WAS ASYMPTOMATIC. FURTHER REPROGRAMMING WAS RECOMMENDED.

Description of Event or Problem · 1

NEW INFORMATION INDICATED THAT DEVICE POST-PACED T-WAVE OVERSENSING WAS AGAIN OBSERVED. FURTHER PROGRAMMING CHANGES WERE RECOMMENDED.

Description of Event or Problem · 1

NEW INFORMATION RECEIVED STATES THAT PERSISTENT POST-PACED T-WAVE OVERSENSING WAS OBSERVED VIA A MERLIN.NET TRANSMISSION. THE DEVICE WAS REPROGRAMMED. THE PATIENT CONDITION IS GOOD.

Description of Event or Problem · 1

NEW INFORMATION RECEIVED NOTES THAT WHEN THE ASYMPTOMATIC PATIENT PRESENTED IN CLINIC DURING FOLLOW-UP, POST-PACED T-WAVE OVERSENSING WAS OBSERVED AGAIN ON STORED EGM. PROGRAMMING CHANGES WERE MADE.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
309585 QUADRA ASSURA CRT-D, DF4 CONNECTOR IMPLANTABLE CARDIOVERTER DEFIBRILLATOR NIK ST JUDE MEDICAL CARDIAC RHYTHM MANAGEMENT DIVISION CD3265-40Q NA

Patients

Seq Age Sex Outcome Treatment
1 69 YR