BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    ASSURITY DR RF

    MDR report key: 3920680 · Received July 8, 2014

    Report

    Report Number
    2017865-2014-14283
    Event Type
    Malfunction
    Date Received
    July 8, 2014
    Date of Event
    May 15, 2014
    Manufacturer
    ST. JUDE MEDICAL, INC., CRMD
    Product Code
    DXY
    PMA / PMN Number
    P880086
    Removal / Correction Number
    NA
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    NY, US
    Reporter Occupation
    PHYSICIAN

    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 DURING THE IMPLANT PROCEDURE, THE PHYSICIAN HAD DIFFICULTY INSERTING A LEAD INTO THE RIGHT VENTRICULAR PORT OF THE PULSE GENERATORS HEADER. ADDITIONAL FORCE RESULTED IN A SUCCESSFUL IMPLANT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    396888 ASSURITY DR RF IMPLANTABLE PACEMAKER PULSE GENERATOR DXY ST. JUDE MEDICAL, INC., CRMD PM2240 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 90 YR