FDA Adverse Event Malfunction Summary report: N

CARELINK

MDR report key: 3990878 · Received August 8, 2014

Report

Report Number
2182208-2014-02206
Event Type
Malfunction
Date Received
August 8, 2014
Date of Event
June 20, 2014
Report Date
June 20, 2014
Manufacturer
MEDTRONIC, INC.
Product Code
KRG
PMA / PMN Number
P890003
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
MN, US
Reporter Occupation
OTHER

Narratives

Additional Manufacturer Narrative · 1

IF INFORMATION IS PROVIDED IN THE FUTURE, A SUPPLEMENTAL REPORT WILL BE ISSUED.

Additional Manufacturer Narrative · 1

THE INFORMATION SUBMITTED REFLECTS ALL RELEVANT DATA RECEIVED. IF ADDITIONAL RELEVANT INFORMATION IS RECEIVED, A SUPPLEMENTAL REPORT WILL BE SUBMITTED. (B)(4).

Additional Manufacturer Narrative · 1

PRODUCT EVENT SUMMARY: ANALYSIS CONFIRMED THE CUSTOMER COMMENT, THE PROGRAMMER WAS ON AND SUDDENLY SHUT OFF AND WOULD NOT RESTART, AND THE POWER SUPPLY WAS THEREFORE REPLACED. IT WAS FURTHER NOTED THAT THE TAB HAD BROKEN OFF OF THE POWER CORD BAY DOOR AND THE POWER CORD BAY WAS ALSO REPLACED. (B)(4).

Description of Event or Problem · 1

IT WAS REPORTED THAT THE PROGRAMMER SCREEN SUDDENLY TURNED BLACK AND THAT THE PROGRAMMER WAS UNABLE TO BE SUCCESSFULLY REBOOTED. THE PROGRAMMER WAS RETURNED FOR SERVICE. NO PATIENT COMPLICATIONS HAVE BEEN REPORTED AS A RESULT OF THIS EVENT.

Description of Event or Problem · 1

IT WAS REPORTED THAT THE PROGRAMMER SCREEN SUDDENLY TURNED BLACK AND THAT THE PROGRAMMER WAS UNABLE TO BE SUCCESSFULLY REBOOTED. THE PROGRAMMER WAS RETURNED FOR SERVICE. NO PATIENT COMPLICATIONS HAVE BEEN REPORTED AS A RESULT OF THIS EVENT.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
470290 CARELINK PROGRAMMER, PACEMAKER KRG MEDTRONIC, INC. 2090W

Patients

Seq Age Sex Outcome Treatment
1 2067L RADIOFREQUENCY PROGRAMMER HEAD| 2067L RADIOFREQUENCY PROGRAMMER HEAD