BEUDAMED
    FDA Adverse Event Injury Summary report: N

    RIATA ACTIVE FIXATION LEAD

    MDR report key: 465985 · Received June 12, 2003

    Report

    Report Number
    2938836-2003-00201
    Event Type
    Injury
    Date Received
    June 12, 2003
    Date of Event
    March 7, 2003
    Report Date
    March 7, 2003
    Manufacturer
    ST. JUDE MEDICAL, INC., CRMD
    Product Code
    LWS
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    AR, US
    Reporter Occupation
    PHYSICIAN

    Narratives

    Description of Event or Problem · 1

    THE ICD WAS EXPLANTED DUE TO INFECTION. THE INFECTION IS BEING REPORTED UNDER AN AGREEMENT THAT WAS COMMUNICATED TO FDA ON NOVEMBER 13, 1997, IN WHICH ALL INFECTIONS OCCURRING WITHIN 30 DAYS OF IMPLANT SHALL BE REPORTED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 RIATA ACTIVE FIXATION LEAD DEFIBRILLATION LEAD LWS ST. JUDE MEDICAL, INC., CRMD 1581 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 55 YR Other V-235, THERAPY DATES: NA