BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    CPS DUO

    MDR report key: 1955873 · Received January 10, 2011

    Report

    Report Number
    2017865-2011-01186
    Event Type
    Malfunction
    Date Received
    January 10, 2011
    Date of Event
    October 21, 2010
    Manufacturer
    ST JUDE MEDICAL CARDIAC RHYTHM MANAGEMENT DIVISION
    Product Code
    DQY
    PMA / PMN Number
    NA
    Removal / Correction Number
    NA
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CA
    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 TIP OF THE GUIDEWIRE BROKE OFF AND WAS LEFT IN THE PATIENT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 CPS DUO GUIDEWIRE DQY ST JUDE MEDICAL CARDIAC RHYTHM MANAGEMENT DIVISION DS2M006 NA

    Patients

    Seq Age Sex Outcome Treatment
    1