BEUDAMED
    FDA Adverse Event Injury Summary report: N

    RIATA ST ACTIVE FIXATION

    MDR report key: 1955150 · Received January 10, 2011

    Report

    Report Number
    2017865-2011-00178
    Event Type
    Injury
    Date Received
    January 10, 2011
    Date of Event
    November 25, 2010
    Manufacturer
    ST JUDE MEDICAL CARDIAC RHYTHM MANAGEMENT DIVISION
    Product Code
    NVY
    PMA / PMN Number
    P950022
    Removal / Correction Number
    NA
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    LA
    Reporter Occupation
    OTHER HEALTH CARE PROFESSIONAL

    Narratives

    Additional Manufacturer Narrative · 1

    ALL INFORMATION PROVIDED BY MANUFACTURER, NO MEDWATCH FORM WAS RECEIVED.

    Description of Event or Problem · 1

    IT WAS REPORTED THAT THE DEVICE DELIVERED INAPPROPRIATE HV THERAPY DUE TO NOISE. REVIEW OF THE STORED EGM SHOWED THE NOISE WAS DUE TO A SUSPECTED LEAD FAILURE ON THE SENSE/PACE PORTION OF THE LEAD. THE LEAD WAS PARTIALLY CAPPED AND REPLACED. THE DEFIB PORTION OF THE LEAD REMAINS ACTIVE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 RIATA ST ACTIVE FIXATION DEFIBRILLATION LEAD NVY ST JUDE MEDICAL CARDIAC RHYTHM MANAGEMENT DIVISION 7001/60 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 80 YR Required Intervention