BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    FLEXCATH STEERABLE SHEATH

    MDR report key: 2120024 · Received June 10, 2011

    Report

    Report Number
    3002648230-2011-00042
    Event Type
    Malfunction
    Date Received
    June 10, 2011
    Date of Event
    May 11, 2011
    Report Date
    May 12, 2011
    Manufacturer
    MEDTRONIC CRYOCATH LP
    Product Code
    DRA
    PMA / PMN Number
    K081049
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    TX, US
    Reporter Occupation
    PHYSICIAN

    Narratives

    Additional Manufacturer Narrative · 1

    THE DEVICE WAS RETURNED AND WAS VISUALLY INSPECTED AND FUNCTIONALLY TESTED. THE REPORTED ISSUE WAS CONFIRMED THROUGH TESTING. DISSECTION SHOWED A LEAKING HEMOSTATIC VALVE.

    Description of Event or Problem · 1

    THE PHYSICIAN REPORTED THAT THE FLEXCATH STEERABLE SHEATH (CATHETER INTRODUCER) WAS LEAKING AT THE VALVE THROUGHOUT THE CRYOABLATION PROCEDURE. THE PROCEDURE WAS COMPLETED AND NO ADVERSE EVENT OCCURRED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 FLEXCATH STEERABLE SHEATH DRA MEDTRONIC CRYOCATH LP 3FC12 23511

    Patients

    Seq Age Sex Outcome Treatment
    1 60 YR