BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    TELIGEN

    MDR report key: 3211312 · Received July 8, 2013

    Report

    Report Number
    2124215-2013-09355
    Event Type
    Malfunction
    Date Received
    July 8, 2013
    Date of Event
    May 14, 2013
    Report Date
    May 14, 2013
    Manufacturer
    GUIDANT CRM CLONMEL IRELAND
    Product Code
    LWS
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Occupation
    HEALTH PROFESSIONAL

    Narratives

    Additional Manufacturer Narrative · 1

    AS NO FURTHER INFORMATION CONCERNING THIS REPORT IS EXPECTED, OUR INVESTIGATION IS COMPLETE. THIS INVESTIGATION WILL BE UPDATED SHOULD FURTHER INFORMATION BE PROVIDED.

    Description of Event or Problem · 1

    BOSTON SCIENTIFIC RECEIVED INFORMATION THAT THIS IMPLANTABLE CARDIOVERTER DEFIBRILLATOR (ICD) DID NOT DELIVER ANTI-TACHYCARDIA PACING (ATP) AS EXPECTED AND DELIVERED AN INAPPROPRIATE SHOCKS FOR VENTRICULAR FIBRILLATION (VF) THAT WAS INITIALLY DETECTED IN THE MONITOR ONLY VT-1 ZONE. RHYTHM WAS DETECTED IN THE VT-1 ZONE AND ACCELERATED INTO THE VENTRICULAR TACHYCARDIA (VT) ZONE AND RESULTED IN A THERAPY INDUCED VENTRICULAR TACHYCARDIA (VT). MULTIPLE INAPPROPRIATE SHOCKS WERE DELIVERED AND SUBSEQUENTLY THERAPY WAS EXHAUSTED. PROGRAMMING CHANGES WERE DISCUSSED. NO ADVERSE PATIENT EFFECTS WERE REPORTED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    310971 TELIGEN IMPLANTABLE CARDIOVERTER DEFIBRILLATOR LWS GUIDANT CRM CLONMEL IRELAND E102

    Patients

    Seq Age Sex Outcome Treatment
    1 62 YR 0185| E102