FDA Adverse Event
Malfunction
Summary report: N
QUADRA ASSURA CRT-D, DF-4 CONNECTOR
MDR report key: 4220966
·
Received November 3, 2014
Report
- Report Number
- 2938836-2014-17403
- Event Type
- Malfunction
- Date Received
- November 3, 2014
- Date of Event
- September 2, 2014
- Manufacturer
- ST. JUDE MEDICAL, INC., CRMD
- Product Code
- NIK
- PMA / PMN Number
- P910023
- Removal / Correction Number
- NA
- Product Problem
- Yes
- Report Source
- Manufacturer report
- Reporter Location
- MO, US
- Reporter Occupation
- NURSE
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 MYOPOTENTIAL OVERSENSING WAS OBSERVED, RESULTING IN BI-V PACING INHIBITION. THE PATIENT WAS NOT SYMPTOMATIC DUE TO THE PACING INHIBITION. THE CLINICIAN PROGRAMMED THE LFA FILTER OFF IN ORDER TO DECREASE THE AMPLITUDE OF THE MYOPOTENTIALS.
Devices
| Seq | Brand | Generic | Product Code | Manufacturer | Model | Lot | UDI-DI |
|---|---|---|---|---|---|---|---|
| 703303 | QUADRA ASSURA CRT-D, DF-4 CONNECTOR | IMPLANTABLE CARDIOVERTER DEFIBRILLATOR | NIK | ST. JUDE MEDICAL, INC., CRMD | CD3365-40Q | NA |
Patients
| Seq | Age | Sex | Outcome | Treatment |
|---|---|---|---|---|
| 1 | 79 YR |