FDA Adverse Event Injury Summary report: N

EASYTRAK 2

MDR report key: 1950556 · Received January 6, 2011

Report

Report Number
2124215-2010-22737
Event Type
Injury
Date Received
January 6, 2011
Date of Event
November 16, 2010
Report Date
December 9, 2010
Manufacturer
CPI - DEL CARIBE
Product Code
OJX
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
CA
Reporter Occupation
MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE

Narratives

Additional Manufacturer Narrative · 1

THIS PRODUCT IS CURRENTLY UNDERGOING DETAILED ANALYSIS. THIS EVENT WILL BE UPDATED UPON COMPLETION OF ANALYSIS.

Additional Manufacturer Narrative · 1

UPON RECEIPT IN OUR POST MARKET QUALITY ASSURANCE LABORATORY, A THOROUGH EVALUATION OF THE LEAD WAS PERFORMED. VISUAL INSPECTION NOTED DRIED BODILY FLUID IN THE LEAD LUMEN. RESISTANCE AND PRESSURE TESTS WERE COMPLETED TO ASSESS THE ELECTRICAL PERFORMANCE AND INSULATION INTEGRITY OF THE LEAD. MEASUREMENTS THROUGHOUT THESE TESTS WERE WITHIN NORMAL LIMITS. GUIDEWIRE INSERTION TESTING DID NOT PASS, NOTED TO BE MOST LIKELY DUE TO BODY FLUID INFILTRATION. MICROSCOPIC INSPECTIONS OF THE TERMINAL PIN ASSEMBLY, LEAD BODY, AND ELECTRODE TIP FOUND NO ANOMALIES. LABORATORY TESTING WAS UNABLE TO REPRODUCE THE REPORTED CLINICAL OBSERVATIONS AND DETAILED ANALYSIS DID NOT REVEAL ANY ABNORMALITIES.

Additional Manufacturer Narrative · 1

AT THIS TIME, THIS PRODUCT HAS NOT BEEN RETURNED TO BOSTON SCIENTIFIC FOR ANALYSIS. THIS INVESTIGATION WILL BE UPDATED SHOULD FURTHER INFORMATION BE PROVIDED.

Description of Event or Problem · 1

BOSTON SCIENTIFIC RECEIVED INFORMATION THAT THIS LEFT VENTRICULAR (LV) LEAD DISLODGED. A REVISION PROCEDURE WAS PERFORMED, DURING WHICH THE LEAD WAS EXPLANTED. TO DATE, THERE HAVE BEEN NO REPORTED ADVERSE PATIENT EFFECTS RELATED TO THIS CLINICAL OBSERVATION.

Description of Event or Problem · 1

THE LEAD WAS LATER RETURNED FOR ANALYSIS.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1 EASYTRAK 2 IMPLANTABLE LEAD OJX CPI - DEL CARIBE 4542

Patients

Seq Age Sex Outcome Treatment
1 61 YR Required Intervention T165| 4542| 4137| N119| 0157| 4037