MAUDE Adverse Event Report: ST. JUDE MEDICAL, CARDIAC RHYTHM MANAGEMENT DIVISI INTEGRITY DR; IMPLANTABLE PACEMAKER PULSE GENERATOR

Model Number 5366

Device Problems Failure to Interrogate (1332); No Device Output (1435)

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

Event Date 11/28/2011

Event Type  Injury  

Event Description

It was reported that during a generator change the device was exposed to electrocautery.Both pacing and telemetry were not possible after this occurred.The device was explanted and returned to sjm for analysis.

Manufacturer Narrative

(b)(4).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.Final analysis could not confirm the loss of output.The device passed all tests and normal battery depletion was confirmed.

• Brand Name: INTEGRITY DR
• Type of Device: IMPLANTABLE PACEMAKER PULSE GENERATOR
• Manufacturer (Section D): ST. JUDE MEDICAL, CARDIAC RHYTHM MANAGEMENT DIVISI; 15900 valley view ct.; sylmar CA 91342
• Manufacturer (Section G): ST. JUDE MEDICAL, CARDIAC RHYTHM MANAGEMENT DIVISI; 15900 valley view ct.; sylmar CA 91342
• Manufacturer Contact: cary lawler ; 15900 valley view ct.; sylmar, CA 91342 ; 8184932621
• MDR Report Key: 4152192
• MDR Text Key: 4929757
• Report Number: 2017865-2014-06327
• Device Sequence Number: 1
• Product Code: DXY
• Combination Product (y/n): N
• Reporter Country Code: US
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: 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

• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: Yes
• Device Operator: Health Professional
• Device Expiration Date: 01/31/2005
• Device Model Number: 5366
• Device Catalogue Number: SMTFY999
• Was Device Available for Evaluation?: Yes
• Date Returned to Manufacturer: 12/01/2011
• Is the Reporter a Health Professional?: Yes
• Distributor Facility Aware Date: 11/28/2011
• Device Age: 8 YR
• Event Location: Hospital
• Initial Date Manufacturer Received: 11/28/2011
• Initial Date FDA Received: 01/13/2014
• Was Device Evaluated by Manufacturer?: Yes
• Date Device Manufactured: 07/01/2003
• 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
• Patient Outcome(s): Required Intervention
• Patient Age: 79 YR