BEUDAMED
    FDA Adverse Event Injury Summary report: N

    RIATA PASSIVE FIXATION

    MDR report key: 2083828 · Received May 10, 2011

    Report

    Report Number
    2017865-2011-03276
    Event Type
    Injury
    Date Received
    May 10, 2011
    Date of Event
    January 31, 2011
    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. ANALYSIS FOUND AN OUTER INSULATION ABRASION AT 5.8CM FROM THE CONNECTOR PIN DUE TO FRICTION TO ICD CAN.

    Description of Event or Problem · 1

    THE PATIENT RECEIVED INAPPROPRIATE THERAPIES DUE TO INSULATION DAMAGE. THE LEAD WAS EXPLANTED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 RIATA PASSIVE FIXATION DEFIBRILLATION LEAD NVY ST JUDE MEDICAL CARDIAC RHYTHM MANAGEMENT DIVISION 1572/65 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 Required Intervention