FDA Adverse Event
Malfunction
Summary report: N
IDENTITY ADX XL DR
MDR report key: 4143120
·
Received January 13, 2014
Report
- Report Number
- 2017865-2014-05649
- Event Type
- Malfunction
- Date Received
- January 13, 2014
- Date of Event
- January 17, 2012
- Manufacturer
- ST. JUDE MEDICAL, CRMD
- Product Code
- DXY
- Product Problem
- Yes
- Report Source
- Manufacturer report
- Reporter Occupation
- OTHER
Narratives
Additional Manufacturer Narrative · 1
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. (B)(6).
Description of Event or Problem · 1
IT WAS REPORTED THAT THE DEVICE EXHIBITED A MESSAGE INDICATING CORRUPT DIAGNOSTICS. IT WAS RESOLVED BY CLEARING THE DIAGNOSTICS. THE DEVICE REMAINED IMPLANTED.
Devices
| Seq | Brand | Generic | Product Code | Manufacturer | Model | Lot | UDI-DI |
|---|---|---|---|---|---|---|---|
| 31990 | IDENTITY ADX XL DR | IMPLANTABLE PACEMAKER PULSE GENERATOR | DXY | ST. JUDE MEDICAL, CRMD | 5386 |
Patients
| Seq | Age | Sex | Outcome | Treatment |
|---|---|---|---|---|
| 1 | 85 YR |