FDA Adverse Event Malfunction Summary report: N

SINGLE CHAMBER PACEMAKER PULSE GENERATOR

MDR report key: 4030 · Received July 6, 1992

Report

Report Number
4030
Event Type
Malfunction
Date Received
July 6, 1992
Date of Event
January 23, 1992
Report Date
March 23, 1992
Manufacturer
INTERMEDICS
Product Code
LWW
Product Problem
Yes
Report Source
User Facility report

Narratives

Description of Event or Problem · 1

THE PATIENT HAS A HISTORY OF ATRIOVENTRICULAR BLOCK/SINUS ARREST WITH SYNCOPE. A PACEMAKER WAS INITIALLY IMPLANTED DURING 1970 AND WAS REPLACED ON SEVERAL OCCASIONS, THE MOST RECENT BEING 7/20/89. THE PATIENT PRESENTED TO THE HOSPITAL ON 1/23/92 FOR PACEMAKER CHECK AND THE UNIT WAS NOTED TO BE NOT SENSING. THE LEAD POSITION WAS SATISFACTORY AND A "BENCH TEST DONE BY INTERMEDICS PACING SYSTEMS ANALYZER REVEALED THAT NO SENSING PARAMETERS COULD BE TELEMETERED. THUS, PULSE GENERATOR MALFUNCTION WAS SUSPECTED. ON 1/24/92, THE PULSE GENERATOR WAS REMOVED AND REPLACED UNDER LOCAL ANESTHESIA. THE PATIENT IS DOING WELL POST-OPERATIVELY.DEVICE LABELED FOR SINGLE USE. PATIENT MEDICAL STATUS PRIOR TO EVENT: FAIR CONDITION. THERE WAS NOT MULTIPLE PATIENT INVOLVEMENT.DEVICE SERVICED IN ACCORDANCE WITH SERVICE SCHEDULE. DATE LAST SERVICED: 01-MAY-91. SERVICE PROVIDED BY: OTHER. SERVICE RECORDS AVAILABLE.NO IMMINENT HAZARD TO PUBLIC HEALTH CLAIMED. DEVICE USED AS LABELED/INTENDED.DEVICE WAS EVALUATED AFTER THE EVENT. METHOD OF EVALUATION: ACTUAL DEVICE INVOLVED IN INCIDENT WAS EVALUATED, PERFORMANCE TESTS PERFORMED. RESULTS OF EVALUATION: ELECTRICAL PROBLEM, NONE OR UNKNOWN, NONE OR UNKNOWN, RATE-MODULATED PACING SENSING FAILURE. CONCLUSION: DEVICE FAILURE DIRECTLY CAUSED EVENT. CERTAINTY OF DEVICE AS CAUSE OF OR CONTRIBUTOR TO EVENT: INVALID DATA. CORRECTIVE ACTIONS: DEVICE PERMANENTLY REMOVED FROM SERVICE, DEVICE RETURNED TO MANUFACTURER/DEALER/DISTRIBUTOR. THE DEVICE WAS NOT DESTROYED/DISPOSED OF.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1 Implant SINGLE CHAMBER PACEMAKER PULSE GENERATOR LWW INTERMEDICS 281-05S N/A

Patients

Seq Age Sex Outcome Treatment
1 33 YR Other