MAUDE MDR 6496869

MDR report key
6496869
Report number
3007972010-2017-00001
Event key
0
Event type
3
Date of event
2017-01-31
Date received
2017-04-17
Adverse event
3
Product problem
0
Patients in event
0
Reporter occupation
1
Health professional
3
Initial report to FDA
3
Event location
3

Manufacturer Contact#

Contact
MR. AL CROUSE
Address
9201 WEST BROADWAY AVE SUITE 650 MINNEAPOLIS MN 55445 US
Phone
763-763-7634
Report source
M
Manufacturer link flag
Y

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1NEO LEGACYIMPLANTABLE PULSE GENERATORCVRX, INC.DSR2100100053-301R N

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12017-04-1701. R

Event Narratives#

D

Patient 1

PATIENT NOTICED WHAT SEEMED LIKE A SMALL PORTION OF THEIR LEAD TRYING TO ERODE THROUGH THEIR SKIN. THE PATIENT EXPERIENCED "SHOCK LIKE" PAINS IF THE AREA WAS TOUCHED. THE PATIENT WAS SEEN ON (B)(6) 2017, AND HAD BEEN EXPERIENCING THEIR SYMPTOMS FOR SEVERAL WEEKS PRIOR. THE SURGEON, DR. (B)(6) EXAMINED THE PATIENT AND REVIEWED AN X-RAY OF THE AREA. THE X-RAY SHOWED WHAT APPEARED TO BE A SMALL PORTION OF A LEAD WIRE WITHOUT INSULATION. THE LOCATION WAS PROXIMAL TO THE DEVICE AND APPEARED TO BE THE NON-WORKING LEFT LEAD. A LEAD REPAIR HAD BEEN ATTEMPTED SEVERAL YEARS PREVIOUSLY ON THE LEFT LEAD, HOWEVER, NO INFORMATION WAS KNOWN ABOUT THE REPAIR. THE PATIENT WAS GETTING A GOOD RESPONSE FROM THE THERAPY BEING DELIVERED ON THE RIGHT LEAD ONLY AND IMPEDANCE OF THIS LEAD WAS GOOD. DR. (B)(6) WANTED TO REMOVE THE DAMAGED PART OF THE LEFT LEAD WITHOUT DISTURBING THE IPG AS IT STILL HAD 18 MONTHS OF BATTERY LIFE. THE REVISION WAS PERFORMED ON (B)(6) 2017 WITHOUT INCIDENT. THE DAMAGED SECTION OF THE LEFT LEAD WAS ACTUALLY INSIDE THE PREVIOUSLY REPAIRED AREA AND NOT EXPOSED OUTSIDE THE BODY. DR. (B)(6) THOUGHT THE ADDITIONAL MATERIAL REQUIRED FOR THE REPAIR WAS RUBBING AGAINST THE PATIENT'S VERY THIN SKIN AND CAUSING DISCOMFORT. THE DAMAGED SECTION WAS REMOVED, AND THEY REPORTED IT WOULD BE RETURNED TO CVRX. THE REMAINING RIGHT LEAD HAD GOOD IMPEDANCE DURING AND AFTER THE PROCEDURE AND THE NEO LEGACY IPG WAS WORKING PROPERLY. THE PATIENT HAS COMPLETELY RECOVERED.