BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    CURRENT ACCEL VR, DF-4 CONNECTOR

    MDR report key: 3903616 · Received June 30, 2014

    Report

    Report Number
    2938836-2014-12841
    Event Type
    Malfunction
    Date Received
    June 30, 2014
    Date of Event
    May 15, 2014
    Manufacturer
    ST. JUDE MEDICAL, INC., CRMD
    Product Code
    LWS
    PMA / PMN Number
    P910023
    Removal / Correction Number
    NA
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    SG
    Reporter Occupation
    OTHER

    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 DEVICE EXHIBITED A DISPLAY ANOMALY. THE DEVICE WAS ALSO MISSING A TEMPLATE SNAPSHOT DUE TO A TELEMETRY DISTURBANCE. RE-INTERROGATION OF THE DEVICE WAS RECOMMENDED. NO FURTHER INFORMATION AVAILABLE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    379816 CURRENT ACCEL VR, DF-4 CONNECTOR IMPLANTABLE CARDIOVERTER DEFIBRILLATOR LWS ST. JUDE MEDICAL, INC., CRMD CD1215-36Q NA

    Patients

    Seq Age Sex Outcome Treatment
    1