MAUDE Adverse Event Report: UNKNOWN RV LEAD; PERMANENT DEFIBRILLATOR ELECTRODES

Model Number 7120Q

Device Problems Over-Sensing (1438); Impedance Problem (2950); Protective Measures Problem (3015)

Patient Problem Insufficient Information (4580)

Event Date 11/14/2021

Event Type  malfunction  

Event Description

Alert: rv lead integrity warning on (b)(6)2021 (2 or more criteria met).Review high rate-ns episodes, 49 sensing integrity counter (short v-v intervals) and rv lead impedance.The oldest high rate-ns episode associated with this observation is dated (b)(6)2021.Lnterminent oversensin noted on ventricular channel.(b)(4).This report reflects information received by fda in the form of a notification per 803.22 (b)(2).

• Brand Name: RV LEAD
• Type of Device: PERMANENT DEFIBRILLATOR ELECTRODES
• Manufacturer (Section D): UNKNOWN
• MDR Report Key: 17536721
• MDR Text Key: 321371978
• Report Number: MW5143605
• Device Sequence Number: 1
• Product Code: NVY
• Combination Product (y/n): N
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Voluntary
• Reporter Occupation: Other
• Type of Report: Initial
• Report Date: 12/01/2021

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 08/12/2023
• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: No
• Device Model Number: 7120Q
• Patient Sequence Number: 1