FDA Adverse Event Injury Summary report: N

LEAD EXTRACTION EVOLUTION RL CONTROLLED-ROTATION DILATOR SHEATH SET

MDR report key: 13713454 · Received March 9, 2022

Report

Report Number
2522007-2022-00008
Event Type
Injury
Date Received
March 9, 2022
Date of Event
February 9, 2022
Report Date
May 5, 2022
Manufacturer
COOK VANDERGRIFT INC
Product Code
DRE
Adverse Event
Yes
Report Source
Manufacturer report
Reporter Location
NL
Reporter Occupation
PHYSICIAN
Health Professional
Yes

Narratives

Additional Manufacturer Narrative · 0

PRODUCT CODE: DRE. PMA/510(K): K141148. THIS REPORT INCLUDES INFORMATION KNOWN AT THIS TIME. A FOLLOW UP REPORT WILL BE SUBMITTED SHOULD ADDITIONAL RELEVANT INFORMATION BECOME AVAILABLE OR UPON COMPLETION OF INVESTIGATION.

Additional Manufacturer Narrative · 0

D2B: PRODUCT CODE: DRE. G4: PMA/510(K): K141148. THE DEVICE WAS NOT RETURNED ON THIS COMPLAINT, THEREFORE A PHYSICAL INVESTIGATION COULD NOT BE PERFORMED AND THE CUSTOMER'S TESTIMONY/LITERATURE IS THE CONFIRMATION OF THE COMPLAINT. THE COMPLAINT ENTERED WITHIN TRACKWISE: "THE PATIENT BECAME HEMODYNAMIC UNSTABLE AND PERICARDIAL EFFUSION WAS DRAINED PERCUTANEOUSLY." PER LITERATURE: "A 57-YEAR-OLD WOMAN WITH A DUAL-CHAMBER ICD WHO HAD EXTERNALIZATION OF HER RIATA 1580 DUAL-COIL IN SITU SHOCK LEAD WHICH WAS FOR 8 YEARS. AN EVOLUTION RL SHEATH WAS USED TO FREE THE LEAD UP TO THE TRICUSPID ANNULUS. AFTER THIS MANEUVER, THE PATIENT BECAME HEMODYNAMIC UNSTABLE AND PERICARDIAL EFFUSION WAS DRAINED PERCUTANEOUSLY. AFTER COMPLETE REMOVAL OF THE ICD LEAD USING THE FEMORAL SNARE, THE PATIENT DETERIORATED DESPITE THE DRAIN AND AN EMERGENT STERNOTOMY WAS PERFORMED DEMONSTRATING LACERATION OF THE RIGHT ATRIAL WALL." THE DEVICE HISTORY RECORD (DHR) COULD NOT BE REVIEWED DUE TO THE LOT USED WITHIN THIS COMPLAINT WAS UNKNOWN. THIS COMPLAINT WILL BE MONITORED, TRACKED, AND TRENDED PER CVI'S POST MARKET SURVEILLANCE AND COMPLAINT HANDLING PROCESSES. A RISK ASSESSMENT WILL BE PERFORMED AND DOCUMENTED PER THE COMPLAINT SUMMARY TAB WITHIN TRACKWISE. THIS REPORT IS REQUIRED BY THE FDA UNDER 21 CFR PART 803. THIS REPORT IS BASED ON UNCONFIRMED INFORMATION SUBMITTED BY OTHERS. NEITHER THE SUBMISSION OF THIS REPORT NOR ANY STATEMENT MADE IN IT IS INTENDED TO BE AN ADMISSION THAT ANY COOK DEVICE IS DEFECTIVE OR MALFUNCTIONED; THAT A DEATH OR SERIOUS INJURY OCCURRED; OR THAT ANY COOK DEVICE CAUSED OR CONTRIBUTED TO; OR IS LIKELY TO CAUSE OR CONTRIBUTE TO A DEATH OR SERIOUS INJURY IF A MALFUNCTION OCCURRED.

Description of Event or Problem · 0

THIS LITERATURE FINDING SPECIFIES TWO MAJOR ADVERSE EVENTS ATTRIBUTED TO THE COOK EVOLUTION RL CONTROLLED-ROTATION DILATOR SHEATH SET DURING A TRANSVENOUS LEAD EXTRACTION (TLE): A (B)(6) WOMAN UNDERWENT A TLE PROCEDURE FOR EXTERNALIZATION OF A RIATA 1580 DUAL-COIL SHOCK LEAD THAT WAS IN PLACE FOR 8 YEARS. A COOK EVOLUTION RL CONTROLLED-ROTATION DILATOR SHEATH SET WAS USED TO FREE THE LEAD TIP TO THE TRICUSPID ANNULUS. THEN, THE PATIENT BECAME HEMODYNAMIC UNSTABLE AND PERICARDIAL EFFUSION WAS DRAINED PERCUTANEOUSLY. AFTER COMPLETE REMOVAL OF THE ICD LEAD USING THE COOK NEEDLE'S EYE SNARE, THE PATIENT DETERIORATED DESPITE THE DRAIN SO AN EMERGENT STERNOTOMY WAS PERFORMED WHICH SHOWED A LACERATION OF THE RIGHT ATRIAL WALL. SHE RECOVERED CLINICALLY AND WAS DOING WELL AT HER 5 YEAR FOLLOW-UP. A (B)(6) MAN WITH A BIVENTRICULAR ICD HAD ATRIAL AND LEFT VENTRICULAR LEAD MALFUNCTION. THE PATIENT EXPERIENCED WEDGING OF A DISTAL PART OF A BIOTRONIK SETROX S53 ATRIAL LEAD IN THE SUBCLAVIAN VEIN. THE COOK EVOLUTION RL CONTROLLED-ROTATION DILATOR SHEATH SET CAUSED EXCESSIVE BLEEDING AT THE VENOUS ENTRY SITE THAT REQUIRED SURGICAL REPAIR. PHYSICIANS DECIDED TO LEAVE REMNANT LEAD IN PLACE.

Description of Event or Problem · 0

N/A.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1574249 LEAD EXTRACTION EVOLUTION RL CONTROLLED-ROTATION DILATOR SHEATH SET DRE COOK VANDERGRIFT INC UNKNOWN

Patients

Seq Age Sex Outcome Treatment
1 Unknown Required Intervention