BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    PROMOTE RF CRT-D

    MDR report key: 4091682 · Received January 13, 2014

    Report

    Report Number
    2938836-2014-04953
    Event Type
    Malfunction
    Date Received
    January 13, 2014
    Date of Event
    September 14, 2012
    Manufacturer
    ST. JUDE MEDICAL INC., CRMD
    Product Code
    NIK
    PMA / PMN Number
    P910023
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CA, US
    Reporter Occupation
    PHYSICIAN

    Narratives

    Additional Manufacturer Narrative · 1

    ALL INFO PROVIDED BY MFR, NO MEDWATCH FORM WAS RECEIVED. THIS HISTORICAL COMPLAINT IS BEING FILED AS PART OF A RETROSPECTIVE REVIEW OF COMPLAINT FILES IN RESPONSE TO A RECENT FDA INSPECTION. THERE IS NO CHARGE TO THE ACTUAL PERFORMANCE OF THE PRODUCT AND THIS REPORT ONLY REPRESENTS AN ENHANCEMENT TO THE REPORTING CRITERIA GOING FORWARD.

    Description of Event or Problem · 1

    IT WAS REPORTED THAT A PT PRESENTED IN CLINIC FOR ROUTINE F/U WITH AN ALERT MESSAGE FOR POSSIBLE OUTPUT CIRCUIT DAMAGE. THERE HAS BEEN SUCCESSFUL CHARGES SINCE THE DETECTION AND THERE ARE NO ABORTED CHARGES NOTED. THE PT HAD AN LVAD IMPLANTED ON THE DATE OF THE ALERT. TECHNICAL SERVICES REQUESTED SESSION RECORDS AND THE DEVICE REMAINS IMPLANTED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    34146 PROMOTE RF CRT-D IMPLANTABLE CARDIOVERTER DEFIBRILLATOR NIK ST. JUDE MEDICAL INC., CRMD 3207-36

    Patients

    Seq Age Sex Outcome Treatment
    1 35 YR