BEUDAMED
    FDA Adverse Event Injury Summary report: N

    DURATA STS OPTIM PASSIVE FIXATION

    MDR report key: 1955207 · Received January 10, 2011

    Report

    Report Number
    2017865-2011-00428
    Event Type
    Injury
    Date Received
    January 10, 2011
    Date of Event
    November 23, 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 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

    DURING A FOLLOW-UP, LEAD DISLODGEMENT WAS OBSERVED. NO SENSING AND LOSS OF CAPTURE WERE NOTED. PHYSICIAN DECIDED TO TURN OFF THE TACHY THERAPY AND HOSPITALIZED THE PATIENT. IT WAS LATER REPORTED THAT THE LEAD WAS EXPLANTED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 DURATA STS OPTIM PASSIVE FIXATION DEFIBRILLATION LEAD NVY ST JUDE MEDICAL CARDIAC RHYTHM MANAGEMENT DIVISION 7170/65 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 Hospitalization| R