FDA Adverse Event Malfunction Summary report: N

ACUITY

MDR report key: 1954135 · Received January 10, 2011

Report

Report Number
2124215-2010-24244
Event Type
Malfunction
Date Received
January 10, 2011
Date of Event
December 15, 2010
Report Date
January 10, 2011
Manufacturer
CPI - DEL CARIBE
Product Code
OJX
Product Problem
Yes
Report Source
Manufacturer report
Reporter Occupation
MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE

Narratives

Additional Manufacturer Narrative · 1

THIS LEAD IS UNDERGOING ANALYSIS. IF ADDITIONAL INFORMATION IS RECEIVED, THIS REPORT WILL BE UPDATED.

Additional Manufacturer Narrative · 1

IF ADDITIONAL INFORMATION IS RECEIVED, THIS REPORT WILL BE UPDATED.

Additional Manufacturer Narrative · 1

UPON RECEIPT AT OUR (B)(4) LABORATORY, A THOROUGH EVALUATION OF THE LEAD WAS PERFORMED. RESISTANCE AND PRESSURE TESTS WERE COMPLETED TO ASSESS LEAD ELECTRICAL PERFORMANCE AND INSULATION INTEGRITY. MEASUREMENTS THROUGHOUT THESE TESTS WERE WITHIN NORMAL LIMITS. 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.

Description of Event or Problem · 1

BOSTON SCIENTIFIC RECEIVED INFORMATION THAT THE PATIENT WITH THIS LEFT VENTRICULAR (LV) LEAD EXPERIENCES SEVERE COUGHING SPELLS. A COUGHING SPELL CAUSED THE LV LEAD TO DISLODGE. THE THRESHOLD MEASUREMENTS HAVE ALSO INCREASED AND THERE IS DIAPHRAGMATIC STIMULATION IN ALL CONFIGURATIONS. A REVISION PROCEDURE WAS SCHEDULED TO PLACE AN EPICARDIAL LEAD DUE TO THE PATIENT'S SEVERE COUGHING ATTACKS. NO ADVERSE PATIENT EFFECTS WERE REPORTED.

Description of Event or Problem · 1

ADDITIONAL INFORMATION INDICATED THAT THIS LEAD WAS EXPLANTED DUE TO BEING UNABLE TO PROGRAM AROUND DIAPHRAGMATIC STIMULATION. THE LEAD WAS RETURNED FOR ANALYSIS.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1 ACUITY IMPLANTABLE LEAD OJX CPI - DEL CARIBE 4555

Patients

Seq Age Sex Outcome Treatment
1 59 YR Required Intervention (B)(4)| (B)(4)| (B)(4)| (B)(4)| (B)(4)| (B)(4)