BEUDAMED
    FDA Adverse Event Injury Summary report: N

    RIATA ACTIVE FIXATION

    MDR report key: 3220276 · Received July 11, 2013

    Report

    Report Number
    2938836-2013-04179
    Event Type
    Injury
    Date Received
    July 11, 2013
    Date of Event
    December 11, 2012
    Report Date
    April 26, 2013
    Manufacturer
    ST JUDE MEDICAL CARDIAC RHYTHM MANAGEMENT DIVISION
    Product Code
    NVY
    PMA / PMN Number
    P950022
    Removal / Correction Number
    Z0457
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    NY
    Reporter Occupation
    OTHER HEALTH CARE PROFESSIONAL

    Narratives

    Additional Manufacturer Narrative · 1

    ALL INFORMATION PROVIDED BY MANUFACTURER AND REPORT (B)(4).

    Description of Event or Problem · 1

    IT WAS REPORTED THAT A PATIENT WITH HISTORY SYNCOPE, VT AND BRADYCARDIA WAS REFERRED FOR AN ICD LEAD REVISION DUE TO EXTERNALIZED CONDUCTORS.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    319438 RIATA ACTIVE FIXATION DEFIBRILLATION LEAD NVY ST JUDE MEDICAL CARDIAC RHYTHM MANAGEMENT DIVISION 1580 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 Required Intervention