BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    PASSIVE PLUS DX

    MDR report key: 3926081 · Received July 10, 2014

    Report

    Report Number
    2017865-2014-15413
    Event Type
    Malfunction
    Date Received
    July 10, 2014
    Date of Event
    May 28, 2014
    Manufacturer
    ST. JUDE MEDICAL, INC., CRMD
    Product Code
    NVN
    PMA / PMN Number
    NA
    Removal / Correction Number
    NA
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    TN, 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 THE ATRIAL LEAD EXHIBITED LOSS OF CAPTURE AND HIGH IMPEDANCE. THE PATIENT EXPERIENCED DIAPHRAGMATIC STIMULATION WHEN PROGRAMMED TO UNIPOLAR MODE. THE DEVICE WAS THEN PROGRAMMED TO BIPOLAR MODE AND THE PATIENT WOULD CONTINUE TO BE MONITORED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    403831 PASSIVE PLUS DX PERMANENT PACEMAKER ELECTRODE NVN ST. JUDE MEDICAL, INC., CRMD 1342T/46 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 55 YR