BEUDAMED
    FDA Adverse Event Injury Summary report: N

    ENDOTAK PLUS TRANSVENOUS DEFIBRILLATION LEAD IS-1

    MDR report key: 120405 · Received September 8, 1997

    Report

    Report Number
    2124215-1997-02218
    Event Type
    Injury
    Date Received
    September 8, 1997
    Date of Event
    June 24, 1997
    Report Date
    July 29, 1997
    Manufacturer
    CARDIAC PACEMAKERS
    Product Code
    LWS
    Removal / Correction Number
    NA
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    DA
    Reporter Occupation
    PHYSICIAN

    Narratives

    Description of Event or Problem · 1

    CPI RECEIVED INFORMATION THAT A PATIENT WITH AN IMPLANTABLE CARDIOVERTER DEFIBRILLATOR (ICD) CAME IN FOR A CABG SURGERY. FOLLOW-UP TESTING PRIOR TO THE SURGERY (JUNE 24, 1997) REVEALED TWO DIFFERENT FAULT CODES. THE PHYSICIAN ELECTED TO EXPLANT THE DEVICE ON JULY 14, 1997, FOLLOWING THE CABG PROCEDURE. DURING THE REPLACEMENT PROCEDURE, THE SECOND DEVICE (MODEL 1763, SERIAL 802904) WAS UNABLE TO CONVERT THE PATIENT DURING DEFIBRILLATION THRESHOLD TESTING, EXTERNAL SHOCK WAS REQUIRED. THE SHOCKING LEAD IMPEDANCE MEASURED LESS THAN 10 OHMS. THE TRANSVENOUS DEFIBRILLATION LEAD (MODEL 0075, SERIAL 000184) WAS SUSPECTED TO HAVE AN INTERMITTENT ELECTRICAL SHORT. A NEW DEVICE AND LEAD WERE IMPLANTED. BOTH DEVICES MODELS 1720 AND 1763 ARE BEING SENT BACK TO CPI FOR ANALYSIS. THE CHRONIC LEAD WAS CAPPED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ENDOTAK PLUS TRANSVENOUS DEFIBRILLATION LEAD IS-1 Implant TRANVENOUS LEAD LWS CARDIAC PACEMAKERS 0075 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 66 YR Required Intervention THE DEVICE 1763/802904 WAS IMPLANTED 14-JUL-1997| THE DEVICE 0095/202271 WAS IMPLANTED 14-JUL-1997| THE DEVICE 1720/250082 WAS IMPLANTED 01-DEC-1994| THE DEVICE 1763/803623 WAS IMPLANTED 14-JUL-1997