FDA Adverse Event Injury Summary report: N

DYNAMIC DECAPOLAR CATHETER

MDR report key: 17524637 · Received August 12, 2023

Report

Report Number
MW5131583
Event Type
Injury
Date Received
August 12, 2023
Date of Event
October 6, 2016
Report Date
November 29, 2016
Manufacturer
BARD
Product Code
DRF
Report Source
Voluntary report
Reporter Occupation
OTHER

Narratives

Description of Event or Problem · 0

IT WAS REPORTED THAT AFTER THE PVC ABLATION THE PATIENT PRESENTED DIAPHORETIC AND THEIR PRESSURE STARTING DROPPING. THE PHYSICIAN USED THE SOUNDSTAR CATHETER TO EVALUATE FOR AN EFFUSION. A PERICARDIAL EFFUSION WAS SEEN ON US. THE PATIENT WAS STABLE AT THE TIME OF THE CALL AND THE PHYSICIAN WAS STILL DECIDING ON FURTHER TREATMENT. THE CASE WAS COMPLETE WHEN THE EFFUSION WAS FOUND. THE ABLATION CATHETER WAS ST DF #D132705. ADDITIONAL INFORMATION WAS RECEIVED ON 10/11/2016; PHYSICIAN'S OPINION REGARDING THE CAUSE OF THE ADVERSE EVENT WAS THAT IT WAS PROCEDURE-RELATED. PHYSICIAN BELIEVES THE INJURY WAS A RESULT OF ADVANCING THE WEBSTER CS CATHETER TOO FAR INTO THE CORONARY SINUS, RESULTING IN THE RUPTURE OF THE DISTAL PORTION OF THE CORONARY SINUS. THEREFORE, THIS EVENT WAS REPORTED TO THE FDA UNDER THE BWI WEBSTER CS CATHETER (MDR REPORT# 2029046-2016-00240) ADDITIONAL INFORMATION WAS LATER RECEIVED ON 11/09/2016: WEBSTER DECAPOLAR WAS NOT USED DURING THIS CASE. BARD DYNAMIC DECAPOLAR WAS USED. THE CATHETER AND THE BOX WAS DISPOSED OF AFTER THE CASE. NO ADDITIONAL INFORMATION IS AVAILABLE. PER THIS INFORMATION THE BWI CATHETER WAS NOT USED AND THEREFORE THIS EVENT IS NOT REPORTABLE TO BWI. THE SUSPECTED DEVICE IS THE BARD DYNAMIC DECAPOLAR CATHETER. PI1-157RXU5. THIS REPORT REFLECTS INFORMATION RECEIVED BY FDA IN THE FORM OF A NOTIFICATION PER 803.22 (B)(2).

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
762886 DYNAMIC DECAPOLAR CATHETER CATHETER, ELECTRODE RECORDING, OR PROBE, ELECTRODE RECORDING DRF BARD

Patients

Seq Age Sex Outcome Treatment
1 Unknown