BEUDAMED
    FDA Adverse Event Injury Summary report: N

    DURATA STS OPTIM ACTIVE FIXATION, DF4 CONNECTOR

    MDR report key: 2984544 · Received February 28, 2013

    Report

    Report Number
    2938836-2013-00512
    Event Type
    Injury
    Date Received
    February 28, 2013
    Date of Event
    January 22, 2013
    Manufacturer
    ST JUDE MEDICAL CARDIAC RHYTHM MANAGEMENT DIVISION
    Product Code
    NVY
    PMA / PMN Number
    P950022
    Removal / Correction Number
    NA
    Adverse Event
    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.

    Description of Event or Problem · 1

    IT WAS REPORTED THAT DURING LEAD IMPLANT THE PATIENT SUDDENLY DEVELOPED VT. THE PHYSICIAN TRIED TO CHANGE THE POSITION OF THE LEAD, THE VT ACCELERATED. EXTERNAL SHOCK WAS DELIVERED THREE TIMES WITHOUT SUCCESS. THE PHYSICIAN QUICKLY EXPLANTED THE LEAD AND CPR WAS ADMINISTERED. THE PATIENT WAS THEN STABILIZED AND WILL BE MONITORED. THE LEAD WAS DISCARDED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    88409 DURATA STS OPTIM ACTIVE FIXATION, DF4 CONNECTOR DEFIBRILLATION LEAD NVY ST JUDE MEDICAL CARDIAC RHYTHM MANAGEMENT DIVISION 7122Q/65 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 Required Intervention