FDA Adverse Event
Injury
Summary report: N
RIATA ACTIVE FIXATION
MDR report key: 1955261
·
Received January 10, 2011
Report
- Report Number
- 2017865-2011-00059
- Event Type
- Injury
- Date Received
- January 10, 2011
- Date of Event
- December 24, 2009
- 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 LATE DUE TO RE-EVALUATION OF EVENT.
Description of Event or Problem · 1
IT WAS REPORTED THAT DURING AN ICD CHANGE OUT, THE SVC CONNECTOR PIN WAS IN A KINKED POSITION WITHIN THE POCKET. A VISUAL INSPECTION OF THE LEAD REVEALED AN INSULATION BREAK. THE SVC CONNECTOR PIN WAS CAPPED AND THE DEVICE WAS REPROGRAMMED WITH SVC OFF.
Devices
| Seq | Brand | Generic | Product Code | Manufacturer | Model | Lot | UDI-DI |
|---|---|---|---|---|---|---|---|
| 1 | RIATA ACTIVE FIXATION | DEFIBRILLATION LEAD | NVY | ST JUDE MEDICAL CARDIAC RHYTHM MANAGEMENT DIVISION | 1580/65 | NA |
Patients
| Seq | Age | Sex | Outcome | Treatment |
|---|---|---|---|---|
| 1 | 21 YR | Required Intervention |