FDA Adverse Event Injury Summary report: N

ATTAIN ABILITY

MDR report key: 3860042 · Received June 10, 2014

Report

Report Number
2649622-2014-05605
Event Type
Injury
Date Received
June 10, 2014
Date of Event
March 6, 2014
Report Date
March 6, 2014
Manufacturer
MPRI
Product Code
OJX
PMA / PMN Number
P080006
Adverse Event
Yes
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
NV, US
Reporter Occupation
OTHER

Narratives

Additional Manufacturer Narrative · 1

CORRECTION: AWARE DATE.

Additional Manufacturer Narrative · 1

PRODUCT EVENT SUMMARY: THE FULL LEAD WAS RETURNED, ANALYZED AND NO ANOMALIES WERE FOUND. VISUAL SUMMARY ANALYSIS OF THE LEAD INDICATED APPARENT EXPLANT DAMAGE AND STRETCHING. THE INFORMATION SUBMITTED REFLECTS ALL RELEVANT DATA RECEIVED. IF ADDITIONAL RELEVANT INFORMATION IS RECEIVED, A SUPPLEMENTAL REPORT WILL BE SUBMITTED. CONCOMITANT PRODUCTS: 6947 LEAD, IMPLANTED: (B)(6) 2012; A 5076 LEAD, IMPLANTED: (B)(6) 2014. (B)(4).

Description of Event or Problem · 1

IT WAS REPORTED THE RIGHT ATRIAL (RA) LEAD AND THE LEFT VENTRICULAR (LV) LEAD DISLODGED. THE RIGHT ATRIAL (RA) LEAD WAS REPOSITIONED AND AN ATTEMPT TO REPLACE THE LEFT VENTRICULAR (LV) LEAD WAS UNSUCCESSFUL DUE TO PATIENT ANATOMY. CONSEQUENTLY, THE SAME LEFT VENTRICULAR (LV) LEAD WAS USED. ALSO REPORTED WAS THAT THE RIGHT ATRIAL (RA) LEAD DEMONSTRATED LOW P WAVES AND THE RIGHT VENTRICULAR (RV) LEAD DEMONSTRATED A LACK OF R WAVES. ADDITIONALLY, THE PATIENT DEVELOPED AN INFECTION AND THE SYSTEM WAS REMOVED AND REPLACED EXCEPT THE LEFT VENTRICULAR (LV) LEAD COULD NOT BE REPLACED DUE TO PATIENT ANATOMY. NO FURTHER PATIENT COMPLICATIONS HAVE BEEN REPORTED AS A RESULT OF THIS EVENT.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
341828 ATTAIN ABILITY DRUG ELUTING PERMANENT LEFT VENTRICULAR (LV) PACEMAKER ELECTRODE OJX MPRI 419688

Patients

Seq Age Sex Outcome Treatment
1 00065 YR Hospitalization| R