BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    RIATA ST OPTIM PASSIVE FIXATION

    MDR report key: 4091978 · Received January 13, 2014

    Report

    Report Number
    2938836-2014-05141
    Event Type
    Malfunction
    Date Received
    January 13, 2014
    Date of Event
    September 20, 2012
    Manufacturer
    ST. JUDE MEDICAL, INC. CRMD
    Product Code
    NVY
    PMA / PMN Number
    P950022
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CA, US
    Reporter Occupation
    NURSE

    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 THE DEVICE EXHIBITED AN OUT OF RANGE PACING LEAD IMPEDANCE. THE DEVICE REMAINS IMPLANTED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    34057 RIATA ST OPTIM PASSIVE FIXATION DIFIBRILLATION LEAD NVY ST. JUDE MEDICAL, INC. CRMD 7071/65

    Patients

    Seq Age Sex Outcome Treatment
    1 55 YR