FDA Adverse Event
Malfunction
Summary report: N
FORTIFY ASSURA VR, DF-4 CONNECTOR
MDR report key: 4173897
·
Received October 15, 2014
Report
- Report Number
- 2938836-2014-16725
- Event Type
- Malfunction
- Date Received
- October 15, 2014
- Date of Event
- August 25, 2014
- Manufacturer
- ST. JUDE MEDICAL, INC., CRMD
- Product Code
- LWS
- PMA / PMN Number
- NA
- Removal / Correction Number
- NA
- Product Problem
- Yes
- Report Source
- Manufacturer report
- 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 UPON REVIEW OF SESSION RECORDS., NON-SUSTAINED LEAD NOISE EPISODES DUE TO MYOPOTENTIAL OVERSENSING WAS OBSERVED. PROGRAMMING CHANGES WERE MADE.
Devices
| Seq | Brand | Generic | Product Code | Manufacturer | Model | Lot | UDI-DI |
|---|---|---|---|---|---|---|---|
| 654041 | FORTIFY ASSURA VR, DF-4 CONNECTOR | IMPLANTABLE CARDIOVERTER DEFIBRILLATOR | LWS | ST. JUDE MEDICAL, INC., CRMD | CD1259-40Q | NA |
Patients
| Seq | Age | Sex | Outcome | Treatment |
|---|---|---|---|---|
| 1 |