BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    RIATA ACTIVE FIXATION

    MDR report key: 3890567 · Received January 13, 2014

    Report

    Report Number
    2938836-2014-04442
    Event Type
    Malfunction
    Date Received
    January 13, 2014
    Date of Event
    September 14, 2011
    Manufacturer
    ST. JUDE MEDICAL INC., CRMD
    Product Code
    LWS
    PMA / PMN Number
    P950022
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    MD, US
    Reporter Occupation
    PHYSICIAN

    Narratives

    Additional Manufacturer Narrative · 1

    ALL INFO PROVIDED BY THE 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 RIGHT VENTRICULAR LEAD EXHIBITED LOSS OF CAPTURE AND HIGH THRESHOLD. THE PHYSICIAN DECIDED TO DECREASE THE RIGHT VENTRICULAR OUTPUT ON THE DEVICE. THE PT WAS IN POOR GENERAL HEALTH.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    27857 RIATA ACTIVE FIXATION DEFIBRILLATION LEAD, LWS LWS ST. JUDE MEDICAL INC., CRMD 1581/65

    Patients

    Seq Age Sex Outcome Treatment
    1 79 YR