BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    QUARTET

    MDR report key: 4192300 · Received January 11, 2014

    Report

    Report Number
    2017865-2014-02171
    Event Type
    Malfunction
    Date Received
    January 11, 2014
    Date of Event
    March 15, 2012
    Manufacturer
    ST. JUDE MEDICAL, INC, CRMD
    Product Code
    DTB
    PMA / PMN Number
    NA
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    FR
    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 LEFT VENTRICULAR LEAD DISLODGED EXHIBITING HIGH THRESHOLD. THE DEVICE WAS REPROGRAMMED SUCCESSFULLY AND IS STILL IMPLANTED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    22444 QUARTET PERMANENT PACEMAKER ELECTRODE, DTB DTB ST. JUDE MEDICAL, INC, CRMD 1458Q/56

    Patients

    Seq Age Sex Outcome Treatment
    1