FDA Adverse Event Injury Summary report: N

FINELINE II

MDR report key: 2162661 · Received July 14, 2011

Report

Report Number
2124215-2011-07343
Event Type
Injury
Date Received
July 14, 2011
Date of Event
July 12, 2005
Report Date
April 20, 2011
Manufacturer
CPI - DEL CARIBE
Product Code
NVN
Adverse Event
Yes
Report Source
Manufacturer report
Reporter Location
WI
Reporter Occupation
PHYSICIAN

Narratives

Additional Manufacturer Narrative · 1

AS NO FURTHER INFORMATION CONCERNING THIS REPORT IS EXPECTED, OUR INVESTIGATION IS COMPLETE. THIS INVESTIGATION WILL BE UPDATED SHOULD FURTHER INFORMATION BE PROVIDED.

Description of Event or Problem · 1

BOSTON SCIENTIFIC RECEIVED INFORMATION THAT THIS PRODUCT WAS PART OF A SYSTEM EXPLANT DUE TO A PATIENT INFECTION. THERE WAS NO REPORT OF ADVERSE PATIENT EFFECTS DUE TO THE EXPLANT PROCEDURE.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1 FINELINE II IMPLANTABLE LEAD NVN CPI - DEL CARIBE 4470

Patients

Seq Age Sex Outcome Treatment
1 67 YR Life Threatening| R 4087| 4470| 4088| 1290