BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    DURATA STS OPTIM ACTIVE FIXATION

    MDR report key: 3881110 · Received January 13, 2014

    Report

    Report Number
    2938836-2014-02245
    Event Type
    Malfunction
    Date Received
    January 13, 2014
    Date of Event
    September 27, 2011
    Manufacturer
    ST. JUDE MEDICAL INC., CRMD
    Product Code
    NVY
    PMA / PMN Number
    P950022
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    US
    Reporter Occupation
    NURSE

    Narratives

    Additional Manufacturer Narrative · 1

    ALL INFORMATION PROVIDED BY MANUFACTURER, NO MEDWATCH FORM WAS RECEIVED. THIS HISTORICAL COMPLAINT IS BEING FILED AS PART OF A RETROSPECTIVE REVIEW OF COMPLAINT FILES IN RESPONSE TO A RECENT FDA INSPECTION. THERE IS NO CHANGE TO THE ACTUAL PERFORMANCE OF THE PRODUCT AND THIS REPORT ONLY REPRESENTS AN ENHANCEMENT TO THE REPORTING CRITERIA GOING FORWARD.

    Description of Event or Problem · 1

    IT WAS REPORTED THAT LOSS OF CAPTURE HAPPENED BEFORE PATIENT WENT INTO AN EPISODE THAT WAS RESCUED BY THE DEVICE. CAPTURING RESUMED RIGHT AFTER THE THERAPY AND NORMAL IN CLINIC. PATIENT WILL BE MONITORED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    30171 DURATA STS OPTIM ACTIVE FIXATION DEFIBRILLATION LEAD, NVY NVY ST. JUDE MEDICAL INC., CRMD 7121/60

    Patients

    Seq Age Sex Outcome Treatment
    1 64 YR