BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    AV PLUS DX BIFURCATED BIPOLAR

    MDR report key: 4121285 · Received January 13, 2014

    Report

    Report Number
    2017865-2014-07070
    Event Type
    Malfunction
    Date Received
    January 13, 2014
    Date of Event
    March 28, 2012
    Manufacturer
    ST. JUDE MEDICAL, CARDIAC RHYTHM MANAGEMENT DIVISION
    Product Code
    DTB
    PMA / PMN Number
    NA
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    US
    Reporter Occupation
    NURSE

    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 CHANGE 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 THE PT PRESENTED IN CLINIC. THE ATRIAL LEAD EXHIBITED LOW IMPEDANCES. THE DEVICE WAS RESOLVED BY REPROGRAMMING. THE LEAD REMAINED IMPLANTED. THE PT WILL CONTINUE TO BE MONITORED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    32311 AV PLUS DX BIFURCATED BIPOLAR PERMANENT PACEMAKER ELECTRODE DTB ST. JUDE MEDICAL, CARDIAC RHYTHM MANAGEMENT DIVISION 1368/58

    Patients

    Seq Age Sex Outcome Treatment
    1 74 YR