BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    QUADRA ASSURA MP ICD

    MDR report key: 6143984 · Received December 4, 2016

    Report

    Report Number
    2938836-2016-15387
    Event Type
    Malfunction
    Date Received
    December 4, 2016
    Date of Event
    October 13, 2016
    Report Date
    October 13, 2016
    Manufacturer
    ST. JUDE MEDICAL, INC.(CRM-SUNNYVALE)
    Product Code
    NIK
    PMA / PMN Number
    P030054
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    IT
    Reporter Occupation
    PHYSICIAN

    Narratives

    Additional Manufacturer Narrative · 1

    (B)(4).

    Description of Event or Problem · 1

    IT WAS REPORTED THE PHYSICIAN COULD NOT INSERT THE LEAD INTO THE HEADER. AS A RESULT, THE DEVICE WAS REPLACED. THE PATIENT WAS IN GOOD CONDITION THE WHOLE TIME.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    794605 QUADRA ASSURA MP ICD IMPLANTABLE CARDIOVERTER DEFIBRILLATOR NIK ST. JUDE MEDICAL, INC.(CRM-SUNNYVALE) CD3371-40QC A000027076

    Patients

    Seq Age Sex Outcome Treatment
    1