FDA Adverse Event
Malfunction
Summary report: N
SPRINT QUATTRO SECURE
MDR report key: 1925247
·
Received December 14, 2010
Report
- Report Number
- 2649622-2010-13768
- Event Type
- Malfunction
- Date Received
- December 14, 2010
- Date of Event
- September 28, 2010
- Manufacturer
- MEDTRONIC PUERTO RICO, INC.
- Product Code
- LWS
- PMA / PMN Number
- P920015/S24
- Removal / Correction Number
- ASKU
- Product Problem
- Yes
- Report Source
- Manufacturer report
- Reporter Location
- NY, 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): THE FULL LEAD WAS RETURNED, ANALYZED AND THE STYLET WAS STUCK IN THE LEAD DISTAL COIL. IT WAS NOTED THAT THE PROXIMAL CONDUCTOR WAS STRETCHED, THE INNER TUBING WAS KINKED/BUCKLED, THE LEAD APPEARED DAMAGED AT IMPLANT, AND THE LEAD WAS STRETCHED.
Description of Event or Problem · 1
IT WAS REPORTED THAT DURING IMPLANT ATTEMPT, THE STYLET WAS STUCK INSIDE THE LEAD. THE LEAD WAS NOT USED. NO PATIENT COMPLICATIONS HAVE BEEN REPORTED AS A RESULT OF THIS EVENT.
Devices
| Seq | Brand | Generic | Product Code | Manufacturer | Model | Lot | UDI-DI |
|---|---|---|---|---|---|---|---|
| 1 | SPRINT QUATTRO SECURE | IMPLANTABLE TACHY LEAD | LWS | MEDTRONIC PUERTO RICO, INC. | 6947 | ASKU |
Patients
| Seq | Age | Sex | Outcome | Treatment |
|---|---|---|---|---|
| 1 | 63 YR | Other |