BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    ACCENT DR RF

    MDR report key: 4191976 · Received January 13, 2014

    Report

    Report Number
    2017865-2014-04551
    Event Type
    Malfunction
    Date Received
    January 13, 2014
    Date of Event
    February 7, 2012
    Manufacturer
    ST. JUDE MEDICAL, INC., CRMD
    Product Code
    DXY
    PMA / PMN Number
    NA
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    FL, US
    Reporter Occupation
    PHYSICIAN

    Narratives

    Additional Manufacturer Narrative · 1

    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. EVALUATION DESCRIPTION: THE REPORTED FIELD EVENT OF SETSCREW ANOMALY WAS CONFIRMED AND WAS DUE TO MEDICAL ADHESIVE CONTAMINATION. MEDICAL ADHESIVE WAS PARTIALLY FILLING THE SETSCREW INSET, IN THE SETSCREW AND CONNECTOR BLOCK THREADS INTERFACE, AND AROUND THE BOTTOM OF THE SEPTUM AND INSIDE THE SEPTUM OPENING. THE DEVICE WAS TESTED AND NO ANOMALIES WERE FOUND.

    Description of Event or Problem · 1

    IT WAS REPORTED THAT SETSCREW ANOMALY WAS NOTED. THE DEVICE WAS EXPLANTED AND RETURNED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    29801 ACCENT DR RF IMPLANTABLE PACEMAKER PULSE GENERATOR DXY ST. JUDE MEDICAL, INC., CRMD PM2210

    Patients

    Seq Age Sex Outcome Treatment
    1 76 YR