FDA Adverse Event
Malfunction
Summary report: N
RIATA ACTIVE FIXATION
MDR report key: 3801359
·
Received May 8, 2014
Report
- Report Number
- 2938836-2014-10982
- Event Type
- Malfunction
- Date Received
- May 8, 2014
- Date of Event
- January 30, 2014
- Manufacturer
- ST. JUDE MEDICAL, INC., CRMD
- Product Code
- LWS
- PMA / PMN Number
- P950022
- Removal / Correction Number
- Z0457
- Product Problem
- Yes
- Report Source
- Manufacturer report
- Reporter Location
- MA, US
- Reporter Occupation
- PHYSICIAN
Narratives
Additional Manufacturer Narrative · 1
ALL INFORMATION PROVIDED BY MANUFACTURER, NO MEDWATCH FORM WAS RECEIVED.
Description of Event or Problem · 1
IT WAS REPORTED THAT AN ASYMPTOMATIC PATIENT PRESENTED IN THE OPERATING ROOM FOR A CHANGE OUT DUE TO NORMAL ERI. EXTERNALIZED CONDUCTORS WERE OBSERVED. NOISE WAS ALSO NOTED. THE LEAD WAS CAPPED AND REPLACED. THE PATIENT CONDITION WAS AND IS STABLE.
Devices
| Seq | Brand | Generic | Product Code | Manufacturer | Model | Lot | UDI-DI |
|---|---|---|---|---|---|---|---|
| 278892 | RIATA ACTIVE FIXATION | DEFIBRILLATION LEAD | LWS | ST. JUDE MEDICAL, INC., CRMD | 1581/65 | NA |
Patients
| Seq | Age | Sex | Outcome | Treatment |
|---|---|---|---|---|
| 1 | 65 YR |