FDA Adverse Event
Malfunction
Summary report: N
QUADRA ASSURA CRT-D
MDR report key: 3220358
·
Received July 11, 2013
Report
- Report Number
- 2938836-2013-04604
- Event Type
- Malfunction
- Date Received
- July 11, 2013
- Date of Event
- January 25, 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
- CA
- 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 THE PATIENT RECEIVED A VIBRATORY NOTIFIER FOR A LEAD NOISE ALERT DUE TO MYOPOTENTIAL OVERSENSING. ALL ELECTRICAL MEASUREMENTS WERE NORMAL. PROGRAMMING CHANGES WERE RECOMMENDED.
Description of Event or Problem · 1
NEW INFORMATION NOTES THE PHYSICIAN ELECTED NOT TO REPROGRAM THE DEVICE. DEVICE WILL BE MONITORED.
Devices
| Seq | Brand | Generic | Product Code | Manufacturer | Model | Lot | UDI-DI |
|---|---|---|---|---|---|---|---|
| 319795 | QUADRA ASSURA CRT-D | IMPLANTABLE CARDIOVERTER DEFIBRILLATOR | NIK | ST JUDE MEDICAL CARDIAC RHYTHM MANAGEMENT DIVISION | CD3265-40 | NA |
Patients
| Seq | Age | Sex | Outcome | Treatment |
|---|---|---|---|---|
| 1 | 73 YR |