BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    RIATA ST PASSIVE FIXATION LEAD

    MDR report key: 3891033 · Received January 13, 2014

    Report

    Report Number
    2938836-2014-03622
    Event Type
    Malfunction
    Date Received
    January 13, 2014
    Date of Event
    November 15, 2012
    Manufacturer
    ST. JUDE MEDICAL INC., CRMD
    Product Code
    LWS
    PMA / PMN Number
    P950022
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    IT
    Reporter Occupation
    PHYSICIAN

    Narratives

    Additional Manufacturer Narrative · 1

    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 A FOLLOW UP INTERROGATION OF THE DEVICE ONE VENTRICULAR FIBRILLATION EPISODE WAS FOUND. PART OF THE SVC CAN EGM OF THE EPISODE WAS NOISY. PATIENT WILL BE MONITORED. THE LEAD REMAINS IMPLANTED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    24272 RIATA ST PASSIVE FIXATION LEAD DEFIBRILLATION LEAD, LWS LWS ST. JUDE MEDICAL INC., CRMD 7040/65

    Patients

    Seq Age Sex Outcome Treatment
    1