BEUDAMED
    FDA Adverse Event Injury Summary report: N

    ENDOTAK RELIANCE

    MDR report key: 3251636 · Received July 29, 2013

    Report

    Report Number
    2124215-2013-12112
    Event Type
    Injury
    Date Received
    July 29, 2013
    Date of Event
    January 1, 2013
    Report Date
    April 25, 2013
    Manufacturer
    CPI - DEL CARIBE
    Product Code
    NVY
    PMA / PMN Number
    P910073
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Occupation
    HEALTH PROFESSIONAL

    Narratives

    Additional Manufacturer Narrative · 1

    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

    BOSTON SCIENTIFIC RECEIVED INFORMATION THAT THE PATIENT WITH THIS THIS RIGHT VENTRICULAR (RV) LEAD AND IMPLANTABLE CARDIOVERTER DEFIBRILLATOR (ICD) REPORTED HEARING THEIR DEVICE BEEPING. THE PATIENT WAS SEEN FOR A DEVICE FOLLOW UP WHERE IT WAS DISCOVERED THAT THE DEVICE HAD RECORDED LOW, OUT OF RANGE SHOCK IMPEDANCE MEASUREMENTS. THE SHOCKING LEAD IMPEDANCE WAS TESTED AND WAS NORMAL. SUBSEQUENTLY, THE SYSTEM CONTINUED TO DISPLAY LOW, OUT OF RANGE SHOCK MEASUREMENTS. THE PATIENT WAS SEEN AGAIN WHERE SYNCHRONOUS 41 AND 45 JOULE SHOCKS WERE DELIVERED TO ASSES THE INTEGRITY OF THE SYSTEM. THE RESULTING MEASUREMENTS WERE IN RANGE. THE PHYSICIAN WILL CONTINUE TO MONITOR THE PATIENT. THERE WERE NO ADVERSE PATIENT EFFECTS REPORTED. THE SYSTEM REMAINS IN SERVICE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    351881 ENDOTAK RELIANCE IMPLANTABLE LEAD NVY CPI - DEL CARIBE 0157

    Patients

    Seq Age Sex Outcome Treatment
    1 67 YR Life Threatening| R H179| 4087| 4512| H175| 0157