BEUDAMED
    FDA Adverse Event Injury Summary report: N

    ENDOTAK RELIANCE

    MDR report key: 4131684 · Received October 1, 2014

    Report

    Report Number
    2124215-2014-17415
    Event Type
    Injury
    Date Received
    October 1, 2014
    Date of Event
    April 1, 2014
    Report Date
    May 12, 2017
    Manufacturer
    CPI - DEL CARIBE
    Product Code
    LWS
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    MD
    Reporter Occupation
    PHYSICIAN

    Narratives

    Additional Manufacturer Narrative · 1

    (B)(4). AT THIS TIME, THE PRODUCT HAS NOT BEEN RETURNED. IF ADDITIONAL INFORMATION SHOULD BECOME AVAILABLE TO OUR COMPANY, THIS EVENT WOULD BE UPDATED.

    Description of Event or Problem · 1

    BOSTON SCIENTIFIC RECEIVED INFORMATION THAT DURING A DEVICE INTERROGATION IT WAS NOTED THAT THE RIGHT VENTRICULAR (RV) LEAD HAD SPIKES IN THE IMPEDANCE FOR THE PAST THREE MONTHS. SUBSEQUENTLY A REVISION PROCEDURE WAS PERFORMED DUE TO A SUSPECTED FRACTURE. DURING THE PROCEDURE THE DEVICE AND LEAD WERE EXPLANTED AND THE PATIENT WAS UPGRADED TO A CARDIAC RESYNCHRONIZATION THERAPY DEFIBRILLATOR (CRT-D). NO ADDITIONAL ADVERSE PATIENT EFFECTS WERE REPORTED.

    Description of Event or Problem · 1

    ADDITIONAL INFORMATION WAS RECEIVED FROM THE CLINIC THAT THE RIGHT VENTRICULAR (RV) LEAD AND IMPLANTABLE CARDIOVERTER DEFIBRILLATOR (ICD) WERE EXPLANTED FIVE DAYS EARLIER THAN PREVIOUSLY NOTED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    612610 ENDOTAK RELIANCE IMPLANTABLE LEAD LWS CPI - DEL CARIBE 0185

    Patients

    Seq Age Sex Outcome Treatment
    1 53 YR Hospitalization| L| R E102| 0185