FDA Adverse Event Malfunction Summary report: N

SINGLE VENTRICULAR PASSIVE FIXTURE TIMED LEAD

MDR report key: 1811 · Received November 20, 1992

Report

Report Number
1811
Event Type
Malfunction
Date Received
November 20, 1992
Date of Event
October 22, 1992
Report Date
October 27, 1992
Manufacturer
MEDTRONIC, INC.
Product Code
DTB
Product Problem
Yes
Report Source
User Facility report

Narratives

Description of Event or Problem · 1

ON OCTOBER 22, 1992, A PATIENT-MALE RECEIVED A MEDTRONIC ACTIVITREX PACEMAKER IMPLNTED BY A CARDIOVASCULAR SURGEON. THIS PACEMAKER WAS IMPLANTED, AS WAS EXPECTED, WITH THE USUAL LEAD OF A SINGLE VENTRICULAR PASSIVE FIXTURE TIMED LEAD IN THE RIGHT VENTRICLE. DURING IMPLANTATION THE REPORTED LEAD IMPEDENCE WAS 1429 OHMS BIPOLAR AND 1450 OHMS UNIPOLAR. SUBSEQUENTLY WITH A 24 HOUR PERIOD, THE ARRHYTHMIA SERVICE IDENTIFIED AN IMPEDANCE OF 1859 OHMS IN THE BIPOLAR MODE, AND ON REPEAT 1750 OHMS BIPOLAR AND 1652 OHMS UNIPOLAR. A CALLED WAS PLACED TO THE MANUFACTURER REPRESENTATIVE WHO NOTED THAT EIGHT SUCH DEFECTIVE LEADS HAVE BEEN NOTED BY THE COMPANY AND THEIR RECOMMENDATION WAS TO RE-IMPLANT ANOTHER LEADINVALID DATA - REGARDING SINGLE USE LABELING OF DEVICE. PATIENT MEDICAL STATUS PRIOR TO EVENT: INVALID DATA. INVALID DATA - REGARDING MULTIPLE PATIENT INVOLVEMENT.INVALID DATA - ON DEVICE SERVICE/MAINTENANCE. NO DATA - REGARDING DATE LAST SERVICED. SERVICE PROVIDED BY: INVALID DATA. INVALID DATA - SERVICE RECORDS AVAILABILITY. INVALID DATA - REGARDING WHETHER EVENT PRESENTS IMMINENT HAZARD. INVALID DATA - WHETHER DEVICE USED AS LABELED/INTENDED. INVALID DATA - REGARDING EVALUATION BY USER AFTER EVENT. METHOD OF EVALUATION: INVALID DATA. RESULTS OF EVALUATION: INVALID DATA. CONCLUSION: INVALID DATA. CERTAINTY OF DEVICE AS CAUSE OF OR CONTRIBUTOR TO EVENT: YES. CORRECTIVE ACTIONS: NO DATA. INVALID DATA - ON DEVICE DESTROYED/DISPOSED OF STATUS.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1 SINGLE VENTRICULAR PASSIVE FIXTURE TIMED LEAD Implant PACEMAKER LEAD DTB MEDTRONIC, INC. 5024M

Patients

Seq Age Sex Outcome Treatment
1 Other