FDA Adverse Event Malfunction Summary report: N

TRANSVENE RV

MDR report key: 3861926 · Received June 10, 2014

Report

Report Number
2182208-2014-01737
Event Type
Malfunction
Date Received
June 10, 2014
Date of Event
April 26, 2014
Report Date
April 29, 2014
Manufacturer
MEDTRONIC, INC.
Product Code
LWS
PMA / PMN Number
P920015
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
MN, US
Reporter Occupation
MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE

Narratives

Additional Manufacturer Narrative · 1

IF INFORMATION IS PROVIDED IN THE FUTURE, A SUPPLEMENTAL REPORT WILL BE ISSUED.

Additional Manufacturer Narrative · 1

THE INFORMATION SUBMITTED REFLECTS ALL RELEVANT DATA RECEIVED. IF ADDITIONAL RELEVANT INFORMATION IS RECEIVED, A SUPPLEMENTAL REPORT WILL BE SUBMITTED. CONCOMITANT PRODUCTS: 4592-53 LEAD, IMPLANTED (B)(6) 2001; 418985 LEAD, IMPLANTED (B)(6) 2001. (B)(4).

Additional Manufacturer Narrative · 1

PRODUCT EVENT SUMMARY: THE ACTUAL PRODUCT WAS NOT RETURNED FOR ANALYSIS. HOWEVER, PERFORMANCE DATA WAS COLLECTED FROM THE DEVICE AND WAS ANALYZED. ANALYSIS OF THE DEVICE MEMORY INDICATED THE IMPEDANCE ON THE LV (LEFT VENTRICULAR) PACING LEAD WAS BEYOND THE EXPECTED UPPER RANGE. SOME IMPEDANCES NOT MEASURED; LV TIP TO RING AND TIP TO COIL ARE UNDEFINED.

Description of Event or Problem · 1

IT WAS REPORTED THAT A TRANSMISSION OBSERVED THE RIGHT VENTRICULAR (RV) LEAD HAD OVERSENSING. THE RV LEAD REMAINS IN USE. IT WAS ALSO REPORTED THAT THE LEFT VENTRICULAR (LV) LEAD MEASURED HIGH IMPEDANCE. THE LV LEAD REMAINS IN USE. NO PATIENT COMPLICATIONS WERE REPORTED AS A RESULT OF THIS EVENT.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
340674 TRANSVENE RV DEFIBRILLATOR, AUTOMATIC IMPLANTABLE CARDIOVERTER LWS MEDTRONIC, INC. 693675

Patients

Seq Age Sex Outcome Treatment
1 00078 YR D224TRK ICD