BEUDAMED
    FDA Adverse Event Injury Summary report: N

    RIATA ACTIVE FIXATION

    MDR report key: 1223526 · Received November 10, 2008

    Report

    Report Number
    2017865-2008-03615
    Event Type
    Injury
    Date Received
    November 10, 2008
    Date of Event
    August 21, 2008
    Manufacturer
    ST JUDE MEDICAL CARDIAC RHYTHM MANAGEMENT DIVISION
    Product Code
    LWS
    PMA / PMN Number
    PMAP95022
    Removal / Correction Number
    NA
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    FL
    Reporter Occupation
    OTHER HEALTH CARE PROFESSIONAL

    Narratives

    Additional Manufacturer Narrative · 1

    NO MEDWATCH FORM WAS RECEIVED.

    Description of Event or Problem · 1

    IT WAS REPORTED THAT THE PATIENT PRESENTED TO THE ER AFTER RECEIVING MULTIPLE THERAPIES DUE TO NOISE. INTERROGATION OF THE DEVICE REVEALED AN EPISODE OF NON-SUSTAINED VF, DUE TO NOISE ON THE LEAD. THE PHYSICIAN WAS ABLE TO CONFIRM THE NOISE ON THE LEAD WITH ISOMETRIC CONTRACTIONS CAUSING THE NOISE TO SHOW ON THE REAL-TIME EGM. THE LEAD WAS CAPPED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 RIATA ACTIVE FIXATION DEFIBRILLATION LEAD LWS ST JUDE MEDICAL CARDIAC RHYTHM MANAGEMENT DIVISION 1580/65 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 Required Intervention