BEUDAMED
    FDA Adverse Event Injury Summary report: N

    UNIFY CRT-D

    MDR report key: 4170200 · Received January 13, 2014

    Report

    Report Number
    2938836-2014-02847
    Event Type
    Injury
    Date Received
    January 13, 2014
    Date of Event
    July 24, 2012
    Manufacturer
    ST. JUDE MEDICAL INC. CRMD
    Product Code
    NIK
    PMA / PMN Number
    P030054
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CA, US
    Reporter Occupation
    OTHER

    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.

    Description of Event or Problem · 1

    IT WAS REPORTED THAT INTERMITTENT UNDERSENSING WAS NOTED. THE PT PRESENTED AT THE ER UNCONSCIOUSLY. THE DEVICE SHOCK DID NOT CONVERT VF RHYTHM. REPROGRAMMING WAS RECOMMENDED. THE DEVICE REMAINED IMPLANTED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    23750 UNIFY CRT-D IMPLANTABLE CARDIOVERTER DEFIBRILLATOR NIK ST. JUDE MEDICAL INC. CRMD CD3231-40

    Patients

    Seq Age Sex Outcome Treatment
    1 72 YR