FDA Adverse Event
Malfunction
Summary report: N
PASSIVE PLUS DX
MDR report key: 4151142
·
Received January 13, 2014
Report
- Report Number
- 2017865-2014-06641
- Event Type
- Malfunction
- Date Received
- January 13, 2014
- Date of Event
- May 15, 2012
- Manufacturer
- ST. JUDE MEDICAL, INC., CRMD
- Product Code
- DTB
- PMA / PMN Number
- NA
- Product Problem
- Yes
- Report Source
- Manufacturer report
- Reporter Location
- PA, US
- Reporter Occupation
- PHYSICIAN
Narratives
Additional Manufacturer Narrative · 1
ALL INFO PROVIDED BY MANUFACTURER, 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 FOR PULSE GENERATOR CHANGE OUT. DURING THE PROCEDURE THE ATRIAL LEAD EXHIBITED LOW LEAD IMPEDANCE. THE LEAD REMAINED IMPLANTED.
Devices
| Seq | Brand | Generic | Product Code | Manufacturer | Model | Lot | UDI-DI |
|---|---|---|---|---|---|---|---|
| 31918 | PASSIVE PLUS DX | PERMANENT PACEMAKER ELECTRODE, DTB | DTB | ST. JUDE MEDICAL, INC., CRMD | 1336T/52 |
Patients
| Seq | Age | Sex | Outcome | Treatment |
|---|---|---|---|---|
| 1 | 78 YR |