BEUDAMED
    FDA Adverse Event Injury Summary report: N

    RIATA ACTIVE FIXATION

    MDR report key: 4261329 · Received January 11, 2014

    Report

    Report Number
    2938836-2014-03778
    Event Type
    Injury
    Date Received
    January 11, 2014
    Date of Event
    November 14, 2011
    Manufacturer
    ST. JUDE MEDICAL INC., CRMD
    Product Code
    NVY
    PMA / PMN Number
    P950022
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CA, US
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 1

    ALL INFO WAS PROVIDED BY 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. (B)(6).

    Description of Event or Problem · 1

    IT WAS REPORTED THAT A PT PRESENTED IN CLINIC FOR FOLLOW UP. PT HAD STORED EGM'S SHOWING NOISE ON THE VENTRICULAR CHANNEL. NOISE WAS RECREATED WITH POCKET MANIPULATION. THE PT HAD RECEIVED A SHOCK WHILE DRIVING AND TURNING LEFT. THE LEAD WILL CONTINUE TO BE MONITORED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    21996 RIATA ACTIVE FIXATION DEFIBRILLATION LEAD NVY ST. JUDE MEDICAL INC., CRMD 1580/65

    Patients

    Seq Age Sex Outcome Treatment
    1 57 YR