BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    QUARTET

    MDR report key: 4192274 · Received January 11, 2014

    Report

    Report Number
    2017865-2014-02169
    Event Type
    Malfunction
    Date Received
    January 11, 2014
    Date of Event
    January 15, 2013
    Manufacturer
    ST. JUDE MEDICAL, INC CRMD
    Product Code
    DTS
    PMA / PMN 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. 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 THE LEAD WAS DISLODGED. AT THIS TIME THE PHYSICIAN REPORTED THAT IT WOULD BE DIFFICULT TO REPOSITION THE LEAD. THIS ISSUE HAS NOT BEEN CLINICALLY RESOLVED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    22183 QUARTET PERMANENT PACEMAKER ELECTRODE, DTS DTS ST. JUDE MEDICAL, INC CRMD 1458Q/86

    Patients

    Seq Age Sex Outcome Treatment
    1