FDA Adverse Event Injury Summary report: N

FINELINE II

MDR report key: 1954165 · Received January 10, 2011

Report

Report Number
2124215-2010-24443
Event Type
Injury
Date Received
January 10, 2011
Date of Event
December 15, 2010
Report Date
December 21, 2010
Manufacturer
CPI - DEL CARIBE
Product Code
NVN
PMA / PMN Number
P960004
Product Problem
Yes
Report Source
Manufacturer report
Reporter Occupation
MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE

Narratives

Additional Manufacturer Narrative · 1

OUR RECORDS INDICATE THIS LEAD REMAINS IMPLANTED. IF ADDITIONAL INFORMATION IS RECEIVED, THIS REPORT WILL BE UPDATED.

Additional Manufacturer Narrative · 1

AS NO FURTHER INFORMATION CONCERNING THIS REPORT IS EXPECTED, OUR INVESTIGATION IS COMPLETE. THIS INVESTIGATION WILL BE UPDATED SHOULD FURTHER INFORMATION BE PROVIDED.

Description of Event or Problem · 1

BOSTON SCIENTIFIC RECEIVED INFORMATION THAT THIS RIGHT ATRIAL (RA) LEAD WAS BEING REPOSITIONED DUE TO DISLODGEMENT. A REVISION PROCEDURE WAS SCHEDULED TO REPOSITION THE LEADS. NO ADVERSE PATIENT EFFECTS WERE REPORTED. ADDITIONAL INFORMATION HAS BEEN REQUESTED; HOWEVER, NO FURTHER INFORMATION IS CURRENTLY AVAILABLE.

Description of Event or Problem · 1

ADDITIONAL INFORMATION INDICATED THAT THE PATIENT WAS NON-COMPLIANT WITH THE PHYSICIAN'S RECOMMENDATIONS TO KEEP HIS LEFT ARM IN A SLING, NOR WOULD THE PATIENT KEEP HIS ARM AT HIS SIDE. THE PATIENT ALSO ADMITTED THAT HE HAD BEEN IN A FIGHT WITH ANOTHER MAN SHORTLY AFTER LEAVING THE HOSPITAL. THESE ISSUES MOST LIKELY ATTRIBUTED TO THE LEADS DISLODGING. A REVISION PROCEDURE WAS PERFORMED AND THE LEADS WERE SUCCESSFULLY REPOSITIONED.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1 FINELINE II IMPLANTABLE LEAD NVN CPI - DEL CARIBE 4469

Patients

Seq Age Sex Outcome Treatment
1 47 YR Required Intervention E110| 0184| 4469