FDA Adverse Event
Malfunction
Summary report: N
CURRENT DR RF
MDR report key: 4153481
·
Received October 8, 2014
Report
- Report Number
- 2938836-2014-16399
- Event Type
- Malfunction
- Date Received
- October 8, 2014
- Date of Event
- September 1, 2014
- Manufacturer
- ST. JUDE MEDICAL, INC., CRMD
- Product Code
- LWS
- PMA / PMN Number
- P910023
- Removal / Correction Number
- NA
- Product Problem
- Yes
- Report Source
- Manufacturer report
- Reporter Location
- AZ, US
- Reporter Occupation
- PHYSICIAN
Narratives
Additional Manufacturer Narrative · 1
ALL INFORMATION PROVIDED BY MANUFACTURER, NO MEDWATCH FORM WAS RECEIVED.
Description of Event or Problem · 1
IT WAS REPORTED THAT THE PATIENT PRESENTED TO THE EMERGENCY ROOM AFTER RECEIVING APPROPRIATE THERAPY. UPON INTERROGATION, THE DEVICE WAS FOUND TO BE IN BACKUP VVI MODE. A DEVICE CODE DOWNLOAD WAS SUCCESSFULLY PERFORMED. THERE WERE NO ADVERSE CONSEQUENCES TO THE PATIENT.
Devices
| Seq | Brand | Generic | Product Code | Manufacturer | Model | Lot | UDI-DI |
|---|---|---|---|---|---|---|---|
| 630980 | CURRENT DR RF | IMPLANTABLE CARDIOVERTER DEFIBRILLATOR | LWS | ST. JUDE MEDICAL, INC., CRMD | 2207-36 | NA |
Patients
| Seq | Age | Sex | Outcome | Treatment |
|---|---|---|---|---|
| 1 | 56 YR |