MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a health professional,other,use report with the FDA on 2020-03-13 for NBIH? TEMPORARY PACING ELECTRODE CATHETER 007153P manufactured by C.r. Bard, Inc. (covington) -1018233.
[183465152]
The investigation is still in progress. Once the investigation is complete a supplemental report will be filed. The device was not returned.
Patient Sequence No: 1, Text Type: N, H10
[183465153]
It was reported that a patient had a temporary pacing electrode placed on (b)(6) 2020 at approximately 6:30 pm. On (b)(6) 2020, the patient's blood pressure suddenly dropped, and the patient developed tachycardia and went into cardiac arrest. An ultrasound was performed which showed pericardial effusion requiring emergency drainage. A ct scan was also performed which showed that the pericardium was perforated. It was also reported that the patient expired.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 1018233-2020-01816 |
| MDR Report Key | 9832474 |
| Report Source | HEALTH PROFESSIONAL,OTHER,USE |
| Date Received | 2020-03-13 |
| Date of Report | 2020-03-30 |
| Date of Event | 2020-02-18 |
| Date Mfgr Received | 2020-03-23 |
| Device Manufacturer Date | 2018-04-10 |
| Date Added to Maude | 2020-03-13 |
| 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 | PHARMACIST |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 3 |
| Event Location | 3 |
| Manufacturer Contact | YONIC ANDERSON |
| Manufacturer Street | 8195 INDUSTRIAL BLVD |
| Manufacturer City | COVINGTON GA 30014 |
| Manufacturer Country | US |
| Manufacturer Postal | 30014 |
| Manufacturer Phone | 7707846100 |
| Manufacturer G1 | C.R. BARD, INC. (COVINGTON) -1018233 |
| Manufacturer Street | 8195 INDUSTRIAL BLVD |
| Manufacturer City | COVINGTON GA 30014 |
| Manufacturer Country | US |
| Manufacturer Postal Code | 30014 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | NBIH? TEMPORARY PACING ELECTRODE CATHETER |
| Generic Name | ELECTROSYSTOLIC TRAINING PROBE |
| Product Code | LDF |
| Date Received | 2020-03-13 |
| Model Number | 007153P |
| Catalog Number | 007153P |
| Lot Number | GFCP2677 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | N |
| Device Age | DA |
| Device Eval'ed by Mfgr | R |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | C.R. BARD, INC. (COVINGTON) -1018233 |
| Manufacturer Address | 8195 INDUSTRIAL BLVD COVINGTON GA 30014 US 30014 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Death | 2020-03-13 |