FDA Adverse Event
Injury
Summary report: N
SPRINT
MDR report key: 3152481
·
Received June 7, 2013
Report
- Report Number
- 2649622-2013-06786
- Event Type
- Injury
- Date Received
- June 7, 2013
- Date of Event
- April 12, 2013
- Report Date
- April 15, 2013
- Manufacturer
- MPRI
- Product Code
- LWS
- PMA / PMN Number
- P920015
- Adverse Event
- Yes
- Product Problem
- Yes
- Report Source
- Manufacturer report
- Reporter Location
- IA, US
- Reporter Occupation
- PHYSICIAN
Narratives
Additional Manufacturer Narrative · 1
THE INFORMATION SUBMITTED REFLECTS ALL RELEVANT DATA RECEIVED. IF ADDITIONAL RELEVANT INFORMATION IS RECEIVED, A SUPPLEMENTAL REPORT WILL BE SUBMITTED. (B)(4).
Description of Event or Problem · 1
IT WAS REPORTED THAT A LEAD INTEGRITY ALERT WAS TRIGGERED DUE TO A SPIKE IN AND HIGH RIGHT VENTRICULAR LEAD PACING IMPEDANCE AND SHORT V-V INTERVALS. A POTENTIAL LEAD FRACTURE WAS FURTHER REPORTED. THE LEAD WAS CAPPED 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 |
|---|---|---|---|---|---|---|---|
| 253073 | SPRINT | DEFIBRILLATOR, AUTOMATIC IMPLANTABLE CARDIOVERTER | LWS | MPRI | 6932-65 |
Patients
| Seq | Age | Sex | Outcome | Treatment |
|---|---|---|---|---|
| 1 | 00057 YR | Hospitalization| R | D224VRC IMPLANTABLE DEFIBRILLATOR |