MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 04 report with the FDA on 2013-07-09 for PATCH 0041 manufactured by Historical Cpi St. Paul.
[3650496]
Boston scientific received information that this product was involved in infection. The lead was detached and had bacteria on it. The field representative was not able to identify what had specifically detached among the leads after attempts were made to obtain additional information. No additional adverse patient effects were reported. All available information indicates that the product was surgically abandoned.
Patient Sequence No: 1, Text Type: D, B5
[10881846]
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
| Report Number | 2124215-2013-10222 |
| MDR Report Key | 3213637 |
| Report Source | 04 |
| Date Received | 2013-07-09 |
| Date of Report | 2013-04-17 |
| Date of Event | 2012-11-17 |
| Date Mfgr Received | 2013-04-17 |
| Date Added to Maude | 2013-07-09 |
| 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 |
| Reporter Occupation | PATIENT FAMILY MEMBER OR FRIEND |
| 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 | PATCH |
| Generic Name | IMPLANTABLE LEAD |
| Product Code | NHW |
| Date Received | 2013-07-09 |
| Model Number | 0041 |
| ID Number | L 67 |
| Device Expiration Date | 1993-10-02 |
| Operator | LAY USER/PATIENT |
| Device Availability | N |
| 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 | 4470 | 1. Hospitalization; 2. Life Threatening; 3. Required No Informationntervention | 2013-07-09 |