FDA Adverse Event Injury Summary report: N

SPRINT QUATTRO SECURE S

MDR report key: 2952457 · Received February 9, 2013

Report

Report Number
2649622-2013-00570
Event Type
Injury
Date Received
February 9, 2013
Date of Event
July 13, 2012
Report Date
November 20, 2012
Manufacturer
MPRI
Product Code
LWS
PMA / PMN Number
P920015
Adverse Event
Yes
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
GM
Reporter Occupation
PHYSICIAN

Narratives

Additional Manufacturer Narrative · 1

PRODUCT EVENT SUMMARY: THE FULL LEAD WAS RETURNED IN SEGMENTS, ANALYZED, AND NO ANOMALIES WERE FOUND. THE DISTAL CONDUCTOR OF THE LEADWAS EXTRINSICALLY OVER-ROTATED, THERE WAS BLOOD ON THE DISTAL CONDUCTOR OF THE LEAD AND IT WAS NOT OBSTRUCTED, THE HELIX OF THE LEAD BECAME EXTRINSICALLY DISTORTED DUE TO PULLING/STRETCHING/OVERSTRESS, THE OVERLAY TUBING OF THE LEAD WAS EXTRINSICALLY BREACHED DUETO A CUT, AND VISUAL SUMMARY ANALYSIS OF THE LEAD INDICATED APPARENT EXPLANT DAMAGE.

Additional Manufacturer Narrative · 1

THIS EVENT OCCURRED OUTSIDE THE US WHERE THE SAME MODEL IS DISTRIBUTED. ALL INFORMATION PROVIDED IS INCLUDED IN THIS REPORT. PATIENT INFORMATION IS NOT GENERALLY AVAILABLE DUE TO CONFIDENTIALITY CONCERNS. (B)(4).

Additional Manufacturer Narrative · 1

PRODUCT EVENT SUMMARY: (B)(4) - PRODUCT PERFORMANCE DATA WAS RECEIVED AND ANALYZED. OVERSENSING WAS NOTED AS ONE VENTRICULAR NON-SUSTAINED EPISODE WAS 200 MS ON (B)(6) 2012.

Additional Manufacturer Narrative · 1

IF INFORMATION IS PROVIDED IN THE FUTURE, A SUPPLEMENTAL REPORT WILL BE ISSUED.

Description of Event or Problem · 1

IT WAS REPORTED THAT THE RIGHT VENTRICULAR LEAD WAS OVERSENSING AND WAS POSSIBLY FRACTURED. OVERSENSING WAS INDUCED DURING PATIENT EXERCISING BUT WAS NOT INDUCED WITH POCKET MANIPULATION. DURING THE REVISION PROCEDURE, THE PHYSICIAN FOUND BLOOD IN ALL HEADER CONNECTORS. NO OVERSENSING WAS NOTED ON THE LEAD AFTER REMOVAL. BOTH THE DEVICE AND LEAD WERE EXPLANTED AND REPLACED. NO PATIENT COMPLICATIONS HAVE BEEN REPORTED AS A RESULT OF THIS EVENT.

Description of Event or Problem · 1

IT WAS REPORTED THAT THE RIGHT VENTRICULAR LEAD WAS OVERSENSING AND WAS POSSIBLY FRACTURED. OVERSENSING WAS INDUCED DURING PATIENT EXERCISING BUT WAS NOT INDUCED WITH POCKET MANIPULATION. DURING THE REVISION PROCEDURE, THE PHYSICIAN FOUND BLOOD IN ALL HEADER CONNECTORS. NO OVERSENSING WAS NOTED ON THE LEAD AFTER REMOVAL. BOTH THE DEVICE AND LEAD WERE EXPLANTED AND REPLACED. NO PATIENT COMPLICATIONS HAVE BEEN REPORTED AS A RESULT OF THIS EVENT.

Description of Event or Problem · 1

IT WAS REPORTED THAT THE RIGHT VENTRICULAR LEAD WAS OVERSENSING AND WAS POSSIBLY FRACTURED. OVERSENSING WAS INDUCED DURING PATIENT EXERCISING BUT WAS NOT INDUCED WITH POCKET MANIPULATION. DURING THE REVISION PROCEDURE, THE PHYSICIAN FOUND BLOOD IN ALL HEADER CONNECTORS. NO OVERSENSING WAS NOTED ON THE LEAD AFTER REMOVAL. BOTH THE DEVICE AND LEAD WERE EXPLANTED AND REPLACED. NO PATIENT COMPLICATIONS HAVE BEEN REPORTED AS A RESULT OF THIS EVENT.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
55856 SPRINT QUATTRO SECURE S DEFIBRILLATOR, AUTOMATIC IMPLANTABLE CARDIOVERTER LWS MPRI 693565

Patients

Seq Age Sex Outcome Treatment
1 00032 YR Hospitalization| R (B)(4) IMPLANTABLE CARDIOVERTER DEFIBRILLATOR (IC