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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: BIOSENSE WEBSTER INC THERMOCOOL® SMART TOUCH® SF BI-DIRECTIONAL NAVIGATION CATHETER; CARDIAC ABLATION PERCUTANEOUS CATHETER

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BIOSENSE WEBSTER INC THERMOCOOL® SMART TOUCH® SF BI-DIRECTIONAL NAVIGATION CATHETER; CARDIAC ABLATION PERCUTANEOUS CATHETER Back to Search Results
Model Number D134805
Device Problem Patient Device Interaction Problem (4001)
Patient Problem Cardiac Tamponade (2226)
Event Date 12/07/2021
Event Type  Injury  
Event Description
It was reported that a (b)(6) female patient underwent a atrial fibrillation (afib) ablation procedure with a thermocool® smart touch® sf bi-directional navigation catheter.The patient suffered a cardiac tamponade requiring monitoring and procedure discontinuation.It was reported that during septal puncture, imaging in the right atrium revealed cardiac tamponade.This occurred during septal puncture.Drainage was attempted but was not performed because pericardial fluid did not accumulate enough to puncture the drainage needle.Although the condition was observed in an angina room, blood pressure, etc.Were stable, and marked pericardial effusion was not confirmed by echocardiography.The procedure was discontinued.The patient was then transferred to the intensive care unit (icu).Additional information was received on the event.The physician commented that relationship with the product was not mentioned.Regarding the cause of this event, the physician stated, "due to the somewhat complex running of blood vessels from the sheath puncture site to the heart, it was difficult to hang the septal puncture needle in the atrium.The relation with the product was not mentioned by the physician in charge.This adverse event was discovered during use of biosense webster products.The physician¿s opinion on the cause of this adverse event is the patient condition and the procedure.No intervention was provided.The patient outcome of the adverse event is improved.
 
Manufacturer Narrative
Initial reporter phone: (b)(6).The device has been reported as discarded, therefore no product investigation can be performed, and the customer complaint cannot be confirmed.A manufacturing record evaluation was performed for the finished device (b)(4) number, and no internal actions related to the complaint was found during the review.If additional information is received regarding this event, a supplemental 3500a report will be submitted to the fda.Manufacturer's reference number: (b)(4).
 
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Brand Name
THERMOCOOL® SMART TOUCH® SF BI-DIRECTIONAL NAVIGATION CATHETER
Type of Device
CARDIAC ABLATION PERCUTANEOUS CATHETER
Manufacturer (Section D)
BIOSENSE WEBSTER INC
31 technology drive, suite 200
irvine CA 92618
Manufacturer (Section G)
BIOSENSE WEBSTER INC (JUAREZ)
circuito interior norte
1820parque industrial salvacar
juarez
MX  
Manufacturer Contact
gabriel alfageme
31 technology dr
irvine, CA 92618
9497898687
MDR Report Key13115818
MDR Text Key287351212
Report Number2029046-2021-02274
Device Sequence Number1
Product Code LPB
UDI-Device Identifier10846835010183
UDI-Public10846835010183
Combination Product (y/n)N
Reporter Country CodeJA
PMA/PMN Number
P030031
Number of Events Reported1
Summary Report (Y/N)N
Report Source Manufacturer
Source Type Foreign,Company Representative
Reporter Occupation Other
Type of Report Initial
Report Date 12/29/2021
1 Device was Involved in the Event
1 Patient was Involved in the Event
Date FDA Received12/29/2021
Is this an Adverse Event Report? Yes
Is this a Product Problem Report? No
Device Operator Health Professional
Device Expiration Date08/24/2022
Device Model NumberD134805
Device Catalogue NumberD134805
Device Lot Number30629150L
Was Device Available for Evaluation? No
Date Manufacturer Received12/07/2021
Was Device Evaluated by Manufacturer? Device Not Returned to Manufacturer
Date Device Manufactured08/25/2021
Is the Device Single Use? Yes
Is This a Reprocessed and Reused Single-Use Device? No
Type of Device Usage Initial
Patient Sequence Number1
Treatment
UNK_SMARTABLATE GENERATOR.
Patient Outcome(s) Life Threatening;
Patient Age78 YR
Patient SexFemale
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