BEUDAMED
    FDA Adverse Event Injury Summary report: N

    ATTAIN ABILITY

    MDR report key: 1855066 · Received October 5, 2010

    Report

    Report Number
    2649622-2010-09254
    Event Type
    Injury
    Date Received
    October 5, 2010
    Date of Event
    August 12, 2010
    Manufacturer
    MEDTRONIC PUERTO RICO, INC.
    Product Code
    OJX
    PMA / PMN Number
    P080006
    Removal / Correction Number
    ASKU
    Report Source
    Manufacturer report
    Reporter Location
    US
    Reporter Occupation
    PHYSICIAN

    Narratives

    Additional Manufacturer Narrative · 1

    THE INFORMATION SUBMITTED REFLECTS ALL RELEVANT DATA RECEIVED. IF ADDITIONAL RELEVANT INFORMATION IS RECEIVED, A SUPPLEMENTAL REPORT WILL BE SUBMITTED. EVALUATION SUMMARY: (B)(4) NO ANOMALIES FOUND; FULL LEAD IN SEGMENTS RETURNED AND ANALYZED. NO EVIDENCE OF A FRACTURE WAS FOUND. THE LEAD APPEARED TO HAVE BEEN CUT IN TWO.

    Description of Event or Problem · 1

    IT WAS REPORTED THAT HIGH THRESHOLD WAS OBSERVED ON THE LEFT VENTRICULAR LEAD. DURING AN ATTEMPT TO REPOSITION THE LEAD, WHILE PULLING BACK WITH A "GENTLE TUG," THE LEAD BROKE. IT WAS EXPLANTED, AND A NEW LEAD WAS SUCCESSFULLY PLACED. NO PATIENT COMPLICATIONS HAVE BEEN REPORTED AS A RESULT OF THIS EVENT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ATTAIN ABILITY IMPLANTABLE PACING LEAD OJX MEDTRONIC PUERTO RICO, INC. 4196 ASKU

    Patients

    Seq Age Sex Outcome Treatment
    1 69 YR Required Intervention 4574 IMPLANTABLE PACING LEAD| 6935 IMPLANTABLE TACHY LEAD| (B)(4) IMPLANTABLE PACEMAKER/CARDIO/DEFIB