MAUDE Adverse Event Report: ST. JUDE MEDICAL INC., CRMD PROMOTE PLUS CRT-D, DF4 CONNECTOR; IMPLANTABLE CARDIOVERTER DEFIBRILLATOR

Model Number CD3211-36Q

Device Problem Difficult to Interrogate (1331)

Patient Problem No Known Impact Or Consequence To Patient (2692)

Event Date 04/27/2012

Event Type  malfunction  

Event Description

It was reported that prior to implant, wireless telemetry failed and the device was unable to interrogate the device.This device was not implanted.

Manufacturer Narrative

All info provided by manufacturer, no medwatch form was rec'd.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.Evaluation description: the anomaly observed in the field was confirmed in the lab.The device was not able to communicate using radio frequency telemetry.Analysis showed the device radio frequency mode was stuck in the initialization step and that prevented communication.

• Brand Name: PROMOTE PLUS CRT-D, DF4 CONNECTOR
• Type of Device: IMPLANTABLE CARDIOVERTER DEFIBRILLATOR
• Manufacturer (Section D): ST. JUDE MEDICAL INC., CRMD; 15900 valley view ct; sylmar CA 91342
• Manufacturer (Section G): ST. JUDE MEDICAL INC., CRMD; 15900 valley view ct; sylmar CA 91342
• Manufacturer Contact: cary lawler ; 15900 valley view ct; sylmar, CA 91342 ; 8184932621
• MDR Report Key: 4091560
• MDR Text Key: 4742909
• Report Number: 2938836-2014-04851
• Device Sequence Number: 1
• Product Code: NIK
• Combination Product (y/n): N
• Reporter Country Code: JA
• PMA/PMN Number: P030054
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Foreign,Health Professional,User Facility,Company Representative
• Reporter Occupation: Physician
• Type of Report: Initial

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 01/13/2014
• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Device Operator: Health Professional
• Device Expiration Date: 06/30/2012
• Device Model Number: CD3211-36Q
• Device Catalogue Number: SMTFY999
• Was Device Available for Evaluation?: Yes
• Date Returned to Manufacturer: 05/14/2012
• Is the Reporter a Health Professional?: Yes
• Distributor Facility Aware Date: 04/27/2012
• Device Age: 16 MO
• Event Location: Hospital
• Date Manufacturer Received: 04/27/2012
• Was Device Evaluated by Manufacturer?: Yes
• Date Device Manufactured: 01/01/2011
• Is the Device Single Use?: Yes
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: Initial
• Patient Sequence Number: 1