MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 07 report with the FDA on 2012-04-09 for UNKNOWN 4312 manufactured by Historical Cpi St. Paul.
[2581043]
Boston scientific received information that this epicardial lead was part of a system revision due to infection. There were no additional adverse effects reported.
Patient Sequence No: 1, Text Type: D, B5
[2821006]
.
Patient Sequence No: 1, Text Type: D, B5
[9892738]
As no further information concerning this report is expected, our investigation is complete. This investigation will be updated should further information be provided.
Patient Sequence No: 1, Text Type: N, H10
[10097670]
.
Patient Sequence No: 1, Text Type: N, H10
| Report Number | 2124215-2012-03911 |
| MDR Report Key | 2522450 |
| Report Source | 07 |
| Date Received | 2012-04-09 |
| Date of Report | 2012-06-28 |
| Date of Event | 2012-02-24 |
| Date Mfgr Received | 2012-06-28 |
| Date Added to Maude | 2012-04-09 |
| Event Key | 0 |
| Report Source Code | Manufacturer report |
| Manufacturer Link | Y |
| Number of Patients in Event | 0 |
| Adverse Event Flag | 3 |
| Product Problem Flag | 3 |
| Reprocessed and Reused Flag | 3 |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 3 |
| Event Location | 0 |
| Manufacturer Contact | SHARON ZURN |
| Manufacturer Street | 4100 HAMLINE AVE. N |
| Manufacturer City | ST. PAUL MN 55112 |
| Manufacturer Postal | 55112 |
| Manufacturer Phone | 6515824786 |
| Manufacturer G1 | HISTORICAL CPI ST. PAUL |
| Manufacturer Street | GUIDANT CORPORATION |
| Manufacturer City | SAINT PAUL MN |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | UNKNOWN |
| Generic Name | IMPLANTABLE LEAD |
| Product Code | NHW |
| Date Received | 2012-04-09 |
| Model Number | 4312 |
| ID Number | --- |
| Device Expiration Date | 1993-11-22 |
| Operator | LAY USER/PATIENT |
| Device Availability | N |
| Device Age | DA |
| Device Eval'ed by Mfgr | R |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | HISTORICAL CPI ST. PAUL |
| Manufacturer Address | GUIDANT CORPORATION SAINT PAUL MN |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 40 | 1. Life Threatening; 2. Required No Informationntervention | 2012-04-09 |