BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    IDENTITY SR

    MDR report key: 4121545 · Received January 13, 2014

    Report

    Report Number
    2017865-2014-07722
    Event Type
    Malfunction
    Date Received
    January 13, 2014
    Date of Event
    September 3, 2012
    Manufacturer
    ST. JUDE MEDICAL, CARDIAC RHYTHM MANAGEMENT DIVISI
    Product Code
    LWP
    PMA / PMN Number
    P880086
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Occupation
    PHYSICIAN

    Narratives

    Additional Manufacturer Narrative · 1

    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 PULSE GENERATOR EXHIBITED AN INAPPROPRIATE RATE DECREASE RESULTING IN BRADYCARDIA. THE DEVICE REMAINED IMPLANTED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    32612 IDENTITY SR LWP ST. JUDE MEDICAL, CARDIAC RHYTHM MANAGEMENT DIVISI 5172

    Patients

    Seq Age Sex Outcome Treatment
    1