FDA Adverse Event Injury Summary report: N

EASYTRAK 2

MDR report key: 3050011 · Received April 10, 2013

Report

Report Number
2124215-2013-03828
Event Type
Injury
Date Received
April 10, 2013
Date of Event
February 19, 2013
Report Date
March 14, 2013
Manufacturer
CPI - DEL CARIBE
Product Code
OJX
Adverse Event
Yes
Product Problem
Yes
Report Source
Manufacturer report
Reporter Occupation
HEALTH PROFESSIONAL

Narratives

Additional Manufacturer Narrative · 1

UPON RECEIPT AT OUR POST MARKET QUALITY ASSURANCE LABORATORY, ANALYSIS FOR THIS LEFT VENTRICULAR (LV) WAS INITIATED. ANALYSIS HAS NOT YET CONCLUDED. AS NO FURTHER INFORMATION CONCERNING THIS REPORT IS AVAILABLE, OUR INVESTIGATION IS COMPLETE. THIS INVESTIGATION WILL BE UPDATED SHOULD FURTHER INFORMATION BE PROVIDED.

Additional Manufacturer Narrative · 1

UPON RECEIPT AT OUR POST MARKET QUALITY ASSURANCE LABORATORY THE LEAD WAS VISUALLY INSPECTED. VISUAL INSPECTION CONFIRMED THE ALLEGATION THAT THE LEAD INSULATION HAD DEGRADED. BLOOD/BODY FLUID WAS NOTED IN THE LEAD LUMEN AND AN EXTRACTION STYLET WAS RETURNED STUCK IN THE LEAD. IT APPEARED THAT ELECTRO-CAUTERY MELTED THE INSULATION AT MANY LOCATIONS ON THE LEAD. NO ADVERSE PATIENT EFFECTS WERE REPORTED. 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

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Description of Event or Problem · 1

BOSTON SCIENTIFIC RECEIVED INFORMATION THAT, UPON EXTRACTION FOR INFECTION, IT APPEARED THAT THE INSULATION OF THIS LEFT VENTRICULAR (LV) LEAD WAS DEGRADED. IT WAS SPECULATED THAT CAUTERY CAUSED THE DEGRADATION AND THE MELTING POINT OF POLYURETHANE WAS DISCUSSED. NO ADVERSE PATIENT EFFECTS WERE REPORTED.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
152650 EASYTRAK 2 IMPLANTABLE LEAD OJX CPI - DEL CARIBE 4543

Patients

Seq Age Sex Outcome Treatment
1 53 YR Hospitalization| L| R 4087| N119| 4549| 0158| 4543