BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    OPTISENSE

    MDR report key: 3924224 · Received July 9, 2014

    Report

    Report Number
    2017865-2014-15130
    Event Type
    Malfunction
    Date Received
    July 9, 2014
    Date of Event
    May 12, 2014
    Manufacturer
    ST. JUDE MEDICAL, INC., CRMD
    Product Code
    NVN
    PMA / PMN Number
    P960013
    Removal / Correction Number
    NA
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    FL, 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 A SYNCOPAL PATIENT WAS PRESENTED IN CLINIC FOR A DEVICE CHECK. THE RIGHT ATRIAL LEAD EXHIBITED LOW IMPEDANCE. THE LEAD REMAINED IMPLANTED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    399774 OPTISENSE PERMANENT PACEMAKER ELECTRODE NVN ST. JUDE MEDICAL, INC., CRMD 1699TC/46 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 86 YR 7096920, BER021326