BEUDAMED
    FDA Adverse Event Injury Summary report: N

    DURATA STS OPTIM PASSIVE FIXATION

    MDR report key: 1895917 · Received November 10, 2010

    Report

    Report Number
    2017865-2010-04654
    Event Type
    Injury
    Date Received
    November 10, 2010
    Date of Event
    September 13, 2010
    Manufacturer
    ST JUDE MEDICAL CARDIAC RHYTHM MANAGEMENT DIVISION
    Product Code
    NVY
    PMA / PMN Number
    P950022
    Removal / Correction Number
    NA
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Occupation
    OTHER HEALTH CARE PROFESSIONAL

    Narratives

    Additional Manufacturer Narrative · 1

    ALL INFORMATION PROVIDED BY MANUFACTURER, NO MEDWATCH FORM WAS RECEIVED A LEAD TIP STIFFNESS TEST WAS PERFORMED AND WAS FOUND TO BE WITHIN SPECIFICATION.

    Description of Event or Problem · 1

    DURING A FOLLOW UP, A CAPTURE ANOMALY, LOW SENSING AND HIGH LEAD IMPEDANCE WERE OBSERVED. FLUOROSCOPY REVEALED THAT THE LEAD SLIGHTLY ADVANCED INTO THE RIGHT VENTRICLE. THE PHYSICIAN SUSPECTED A PERICARDIAL EFFUSION. HENCE, THE LEAD WAS EXPLANTED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 DURATA STS OPTIM PASSIVE FIXATION DEFIBRILLATION LEAD NVY ST JUDE MEDICAL CARDIAC RHYTHM MANAGEMENT DIVISION 7170/65 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 70 YR Required Intervention