BEUDAMED
    FDA Adverse Event Injury Summary report: N

    DURATA STS OPTIM ACTIVE FIXATION, DF4 CONNECTOR

    MDR report key: 3781883 · Received April 30, 2014

    Report

    Report Number
    2938836-2014-09958
    Event Type
    Injury
    Date Received
    April 30, 2014
    Date of Event
    February 14, 2014
    Manufacturer
    ST. JUDE MEDICAL, INC., CRMD
    Product Code
    NVY
    PMA / PMN Number
    P950022
    Removal / Correction Number
    NA
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    OH, US
    Reporter Occupation
    PHYSICIAN

    Narratives

    Description of Event or Problem · 1

    IT WAS REPORTED THAT THE PATIENT PRESENTED IN THE OPERATING ROOM FOR A LEAD REVISION DUE TO DECREASED PACING LEAD IMPEDANCE AND HIGH CAPTURE THRESHOLD. THE LEAD WAS REPOSITIONED SUCCESSFULLY. THE PATIENT WAS DOING WELL.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    259186 DURATA STS OPTIM ACTIVE FIXATION, DF4 CONNECTOR DEFIBRILLATION LEAD NVY ST. JUDE MEDICAL, INC., CRMD 7120Q/52 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 72 YR Required Intervention