FDA Adverse Event
Injury
Summary report: N
FINELINE II
MDR report key: 3912269
·
Received July 3, 2014
Report
- Report Number
- 2124215-2014-11274
- Event Type
- Injury
- Date Received
- July 3, 2014
- Date of Event
- May 12, 2014
- Report Date
- May 12, 2014
- Manufacturer
- CPI - DEL CARIBE
- Product Code
- DTB
- Adverse Event
- Yes
- Product Problem
- Yes
- Report Source
- Manufacturer report
- Reporter Location
- IA
- Reporter Occupation
- PHYSICIAN
Narratives
Additional Manufacturer Narrative · 1
(B)(4). AS NO FURTHER INFORMATION CONCERNING THIS REPORT IS EXPECTED, OUR INVESTIGATION IS COMPLETE. THIS INVESTIGATION WILL BE UPDATED SHOULD FURTHER INFORMATION BE PROVIDED.
Description of Event or Problem · 1
BOSTON SCIENTIFIC RECEIVED INFORMATION THAT THIS RIGHT VENTRICULAR (RV) LEAD EXHIBITED UNDERSENSING AND HIGH PACING THRESHOLD JUST THREE DAYS AFTER IMPLANT. THE LEAD WAS REPOSITIONED. ADDITIONAL INFORMATION RECEIVED INDICATED THAT THE ABOVE FINDINGS WERE DUE TO MICRODISLODGEMENT. THIS RV LEAD REMAINS IN SERVICE. NO ADDITIONAL ADVERSE PATIENT EFFECTS WERE REPORTED.
Devices
| Seq | Brand | Generic | Product Code | Manufacturer | Model | Lot | UDI-DI |
|---|---|---|---|---|---|---|---|
| 391663 | FINELINE II | IMPLANTABLE LEAD | DTB | CPI - DEL CARIBE | 4473 |
Patients
| Seq | Age | Sex | Outcome | Treatment |
|---|---|---|---|---|
| 1 | 77 YR | Hospitalization| L| R | K064| 4473| 4472 |