FDA Adverse Event Malfunction Summary report: N

FAST-CATH INTRODUCER, TRANSSEPTAL, 8F, SLO CURVE

MDR report key: 1935881 · Received December 3, 2010

Report

Report Number
3005188751-2010-00123
Event Type
Malfunction
Date Received
December 3, 2010
Date of Event
November 4, 2010
Report Date
November 8, 2010
Manufacturer
ST. JUDE MEDICAL, AF DIV
Product Code
DYB
PMA / PMN Number
K061015
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
JA
Reporter Occupation
PHYSICIAN

Narratives

Additional Manufacturer Narrative · 1

WE ARE AWAITING DEVICE RETURN. WHEN OUR INVESTIGATION HAS BEEN COMPLETED A F/U REPORT WILL BE SUBMITTED. (B)(4).

Description of Event or Problem · 1

IT WAS REPORTED AIR BUBBLES WERE OBSERVED ON THE ARM OF THE STOPCOCK TUBE WHEN THE PHYSICIAN ATTEMPTED TO FLUSH THE DEVICE. THERE WERE NO CONSEQUENCES TO THE PT.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1 FAST-CATH INTRODUCER, TRANSSEPTAL, 8F, SLO CURVE FAST-CATH INTRO. 8F, SLO DYB ST. JUDE MEDICAL, AF DIV 406948 3142671

Patients

Seq Age Sex Outcome Treatment
1 UNK