BEUDAMED
    FDA Adverse Event Injury Summary report: N

    RIATA ACTIVE FIXATION LEAD

    MDR report key: 3880176 · Received January 13, 2014

    Report

    Report Number
    2938836-2014-02181
    Event Type
    Injury
    Date Received
    January 13, 2014
    Date of Event
    November 29, 2012
    Manufacturer
    ST. JUDE MEDICAL, INC., CRMD
    Product Code
    LWS
    PMA / PMN Number
    P950022
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CA
    Reporter Occupation
    PHYSICIAN

    Narratives

    Additional Manufacturer Narrative · 1

    ALL INFORMATION PROVIDED BY MANUFACTURER, NO MEDWATCH FORM WAS RECEIVED. THIS HISTORICAL COMPLAINT IS BEING FILED AS PART OF A RETROSPECTIVE REVIEW OF COMPLAINT FILES IN RESPONSE TO A RECENT FDA INSPECTION. THERE IS NO CHANGE TO THE ACTUAL PERFORMANCE OF THE PRODUCT AND THIS REPORT REPRESENTS AN ENHANCEMENT TO THE REPORTING CRITERIA GOING FORWARD.

    Description of Event or Problem · 1

    IT WAS REPORTED THAT AT PATIENT FOLLOW UP, HIGH LEAD IMPEDANCE AND HIGH CAPTURE THRESHOLD WERE OBSERVED. LEAD WAS CAPPED AND REPLACED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    27043 RIATA ACTIVE FIXATION LEAD DEFIBRILLATION LEAD, LWS LWS ST. JUDE MEDICAL, INC., CRMD 1580/65

    Patients

    Seq Age Sex Outcome Treatment
    1 72 YR Required Intervention