FDA Adverse Event Injury Summary report: N

REPLY

MDR report key: 5194219 · Received November 2, 2015

Report

Report Number
1000165971-2015-00662
Event Type
Injury
Date Received
November 2, 2015
Date of Event
September 30, 2015
Report Date
October 6, 2015
Manufacturer
SORIN GROUP ITALIA S.R.L. - CRM FACILITY
Product Code
NVZ
PMA / PMN Number
PP950029
Adverse Event
Yes
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
JA
Reporter Occupation
PHYSICIAN

Narratives

Additional Manufacturer Narrative · 1

PHYSICIAN DECIDED TO PERFORM THE RECOMMENDED HARDWARE RESET PROCEDURE DURING A FOLLOW-UP SCHEDULED ON (B)(6) 2016. RECOMMENDATIONS WERE SENT ON (B)(6) 2016 TO PROVIDE THE PASSWORD NECESSARY TO PERFORM THE HARDWARE RESET PROCEDURE. PLEASE REFER TO THE ATTACHED PRELIMINARY ANALYSIS REPORT.

Description of Event or Problem · 1

AT A PACEMAKER CHECK ON (B)(6) 2015, AFTER RADIATION THERAPY, IT WAS REPORTEDLY IMPOSSIBLE TO INTERROGATE THE PACEMAKER DUE TO WRONG POSITIONING OF THE TELEMETRY HEAD. THE PROGRAMMER WAS RESTARTED, AND THE PACEMAKER INTERROGATION WAS THEN SUCCESSFULLY PERFORMED. HOWEVER, PACEMAKER WAS FOUND IN STANDBY MODE. PRELIMINARY ANALYSIS CONFIRMED THE REPORTED SWITCH TO STANDBY MODE. IT WAS MOST PROBABLY DUE TO A SINGLE EVENT UPSET (SEU). TELEMETRY ERRORS OCCURRED DURING THE RE-INITIALIZATION PROCESS PERFORMED ON (B)(6) 2015, AND INTERRUPTED IT. CONSEQUENTLY, NORMAL BEHAVIOR OF THE PACEMAKER HAS BEEN RESTORED, EXCEPT FOR THE DISPLAY OF THE BATTERY TABLE WHICH HAS BEEN CORRUPTED. ONLY A HARDWARE RESET COULD RESTORE THE BATTERY TABLE.

Description of Event or Problem · 1

AT A PACEMAKER CHECK ON (B)(6) 2015, AFTER RADIATION THERAPY, IT WAS REPORTEDLY IMPOSSIBLE TO INTERROGATE THE PACEMAKER DUE TO WRONG POSITIONING OF THE TELEMETRY HEAD. THE PROGRAMMER WAS RESTARTED, AND THE PACEMAKER INTERROGATION WAS THEN SUCCESSFULLY PERFORMED. HOWEVER, PACEMAKER WAS FOUND IN STANDBY MODE. PRELIMINARY ANALYSIS CONFIRMED THE REPORTED SWITCH TO STANDBY MODE. IT WAS MOST PROBABLY DUE TO A SINGLE EVENT UPSET (SEU). TELEMETRY ERRORS OCCURRED DURING THE RE-INITIALIZATION PROCESS PERFORMED ON (B)(6) 2015, AND INTERRUPTED IT. CONSEQUENTLY, NORMAL BEHAVIOR OF THE PACEMAKER HAS BEEN RESTORED, EXCEPT FOR THE DISPLAY OF THE BATTERY TABLE WHICH HAS BEEN CORRUPTED. ONLY A HARDWARE RESET COULD RESTORE THE BATTERY TABLE.

Description of Event or Problem · 1

AT A PACEMAKER CHECK ON (B)(6) 2015, AFTER RADIATION THERAPY, IT WAS REPORTEDLY IMPOSSIBLE TO INTERROGATE THE PACEMAKER DUE TO WRONG POSITIONING OF THE TELEMETRY HEAD. THE PROGRAMMER WAS RESTARTED, AND THE PACEMAKER INTERROGATION WAS THEN SUCCESSFULLY PERFORMED. HOWEVER, PACEMAKER WAS FOUND IN STANDBY MODE. PRELIMINARY ANALYSIS CONFIRMED THE REPORTED SWITCH TO STANDBY MODE. IT WAS MOST PROBABLY DUE TO A SINGLE EVENT UPSET (SEU). TELEMETRY ERRORS OCCURRED DURING THE RE-INITIALIZATION PROCESS PERFORMED ON (B)(6) 2015, AND INTERRUPTED IT. CONSEQUENTLY, NORMAL BEHAVIOR OF THE PACEMAKER HAS BEEN RESTORED, EXCEPT FOR THE DISPLAY OF THE BATTERY TABLE WHICH HAS BEEN CORRUPTED. ONLY A HARDWARE RESET COULD RESTORE THE BATTERY TABLE.

Description of Event or Problem · 1

AT A PACEMAKER CHECK ON (B)(6) 2015, AFTER RADIATION THERAPY, IT WAS REPORTEDLY IMPOSSIBLE TO INTERROGATE THE PACEMAKER DUE TO WRONG POSITIONING OF THE TELEMETRY HEAD. THE PROGRAMMER WAS RESTARTED, AND THE PACEMAKER INTERROGATION WAS THEN SUCCESSFULLY PERFORMED. HOWEVER, PACEMAKER WAS FOUND IN STANDBY MODE. PRELIMINARY ANALYSIS CONFIRMED THE REPORTED SWITCH TO STANDBY MODE. IT WAS MOST PROBABLY DUE TO A SINGLE EVENT UPSET (SEU). TELEMETRY ERRORS OCCURRED DURING THE RE-INITIALIZATION PROCESS PERFORMED ON (B)(6) 2015, AND INTERRUPTED IT. CONSEQUENTLY, NORMAL BEHAVIOR OF THE PACEMAKER HAS BEEN RESTORED, EXCEPT FOR THE DISPLAY OF THE BATTERY TABLE WHICH HAS BEEN CORRUPTED. ONLY A HARDWARE RESET COULD RESTORE THE BATTERY TABLE.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
725216 REPLY PULSE GENERATOR, PERMANENT, IMPLANTABLE NVZ SORIN GROUP ITALIA S.R.L. - CRM FACILITY REPLY DR 2511

Patients

Seq Age Sex Outcome Treatment
1 Required Intervention