BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    DURATA STS OPTIM ACTIVE FIXATION

    MDR report key: 3881177 · Received January 13, 2014

    Report

    Report Number
    2938836-2014-02201
    Event Type
    Malfunction
    Date Received
    January 13, 2014
    Date of Event
    January 11, 2013
    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
    PHYSICIAN

    Narratives

    Additional Manufacturer Narrative · 1

    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 THE LEAD EXHIBITED A SINGLE LOW OUT OF RANGE HIGH VOLTAGE LEAD IMPEDANCE. THE PT PRESENTED TO THE ER AFTER RECEIVING AN ALERT FOR OUT OF RANGE IMPEDANCE. THE LEAD EXHIBITED NORMAL AND IN RANGE VALUES FOR ALL OTHER MEASUREMENTS. THE PT WOULD BE MONITORED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    31410 DURATA STS OPTIM ACTIVE FIXATION DEFIBRILLATION LEAD NVY ST. JUDE MEDICAL INC., CRMD 7121/60

    Patients

    Seq Age Sex Outcome Treatment
    1 60 YR