BEUDAMED
    FDA Adverse Event Injury Summary report: N

    RIATA ACTIVA FIXATION LEAD

    MDR report key: 3890326 · Received January 13, 2014

    Report

    Report Number
    2938836-2014-03683
    Event Type
    Injury
    Date Received
    January 13, 2014
    Date of Event
    December 11, 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 Occupation
    PHYSICIAN

    Narratives

    Additional Manufacturer Narrative · 1

    ALL INFO WAS PROVIDED BY MFR, 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 ONLY REPRESENTS AN ENHANCEMENT TO THE REPORTING CRITERIA GOING FORWARD.

    Description of Event or Problem · 1

    IT WAS REPORTED THAT THE LEAD WAS EXPERIENCING INCREASING THRESHOLDS AND INCREASING IMPEDANCE. THE LEAD WAS CAPPED AND REPLACED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    30424 RIATA ACTIVA FIXATION LEAD DEFIBRILLATION LEAD LWS ST. JUDE MEDICAL INC., CRMD 1581/65

    Patients

    Seq Age Sex Outcome Treatment
    1 77 YR Required Intervention