BEUDAMED
    FDA Adverse Event Injury Summary report: N

    ENDOTAK RELIANCE

    MDR report key: 7216097 · Received January 24, 2018

    Report

    Report Number
    2124215-2018-01616
    Event Type
    Injury
    Date Received
    January 24, 2018
    Date of Event
    April 1, 2014
    Report Date
    January 30, 2018
    Manufacturer
    CPI - DEL CARIBE
    Product Code
    LWS
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    KS, US
    Reporter Occupation
    PHYSICIAN

    Narratives

    Additional Manufacturer Narrative · 1

    AT THIS TIME, THE PRODUCT REMAINS IN SERVICE. IF ADDITIONAL INFORMATION IS RECEIVED, THIS REPORT WILL BE UPDATED.

    Additional Manufacturer Narrative · 1

    AT THIS TIME, THE PRODUCT HAS NOT BEEN RETURNED. IF THE PRODUCT IS RETURNED, ANALYSIS WILL BE PERFORMED AND THIS REPORT WOULD BE UPDATED AT THAT TIME.

    Description of Event or Problem · 1

    BOSTON SCIENTIFIC RECEIVED INFORMATION THAT THIS RIGHT VENTRICULAR (RV) LEAD SHOCK IMPEDANCE ROSE TO APPROXIMATELY 108-175 OHMS, AMONG VARIOUS LEAD VECTOR CONFIGURATIONS. THE SHOCK IMPEDANCE WAS REPORTEDLY STABLE IN (B)(6). IT WAS ALSO NOTED THAT IN (B)(6) OF 2014, THE SHOCK IMPEDANCE WAS ABOUT 93 OHMS FROM AN 11 JOULE SHOCK. THE PATIENT WAS TO FOLLOW-UP WITH AN AREA ELECTROPHYSIOLOGIST AND NO FURTHER INFORMATION IS KNOWN AT THIS TIME. NO ADVERSE PATIENT EFFECTS WERE REPORTED.

    Description of Event or Problem · 1

    ADDITIONAL INFORMATION INDICATED THAT THIS RIGHT VENTRICULAR (RV) LEAD HIGH SHOCK LEAD IMPEDANCE CONTINUED TO MEASURE ABOUT 141-177 OHMS. THE RV LEAD WAS SUBSEQUENTLY ABANDONED SURGICALLY AND REPLACED. THE CAUSE OF THE ISSUE REMAINS UNKNOWN. NO ADDITIONAL ADVERSE PATIENT EFFECTS WERE REPORTED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    58906 ENDOTAK RELIANCE IMPLANTABLE LEAD LWS CPI - DEL CARIBE 0185

    Patients

    Seq Age Sex Outcome Treatment
    1 59 YR Hospitalization| L| R