BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    CONFIRM

    MDR report key: 4151158 · Received January 13, 2014

    Report

    Report Number
    2017865-2014-06661
    Event Type
    Malfunction
    Date Received
    January 13, 2014
    Date of Event
    September 18, 2012
    Manufacturer
    ST. JUDE MEDICAL, CARDIAC RHYTHM MANAGEMENT DIVISION
    Product Code
    MXC
    PMA / PMN Number
    K081365
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    FL, 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 CHANGE TO THE ACTUAL PERFORMANCE OF THE PRODUCT AND THIS REPORT ONLY REPRESENTS AN ENHANCEMENT TO THE REPORTING CRITERIA GOING FORWARD. FINAL ANALYSIS FOUND NO ANOMALIES. THE DEVICE SHOWED NORMAL FUNCTION IN THE LAB.

    Description of Event or Problem · 1

    IT WAS REPORTED THAT A DEVICE WAS UNABLE TO BE INTERROGATED. THE DEVICE WAS EXPLANTED AND REPLACED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    27708 CONFIRM IMPLANTABLE CARDIAC MONITOR MXC ST. JUDE MEDICAL, CARDIAC RHYTHM MANAGEMENT DIVISION DM2100

    Patients

    Seq Age Sex Outcome Treatment
    1 83 YR