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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 Pneumonia (2011)
Event Date 05/24/2023
Event Type  Injury  
Event Description
It was reported that a patient underwent an atrial fibrillation (afib) ablation procedure with a thermocool® smart touch® sf bi-directional navigation catheter.The patient suffered pneumonia which required prolonged hospitalization.It was reported that after pulmonary vein isolation (pvi), saturation decreased (50%) and the patient was foaming at the mouth.Based on the diagnosis, the patient was diagnosed with suspected aspiration pneumonia, which was probably caused by gastric juice entering the lungs.The patient was treated to restore saturation and then exited the room.Description of health hazard was suspected aspiration pneumonia.The physician assessment of the health problem was that no causal relationship with the product.There were no abnormalities observed prior to and during use of the product.The adverse event occurred on (b)(6) 2023.It was discovered post use of biosense webster products.The physician¿s opinion on the cause of this adverse event was that it was procedure or patient condition related.Not related to product.Intervention provided was aspiration of vomit and tracheal intubation was performed.The patient required extended hospitalization because of the adverse event as it was extended until the patient has recovered from the state worsened by low saturation.The patient fully recovered.Generator information was smartablate generator, model: m4900207, serial number: (b)(6).
 
Manufacturer Narrative
E 1.Initial reporter phone: +(b)(6).E 1.Initial reporter facility name (cont.): (b)(6) memorial hospital additional information received indicates that the device is not available for return, therefore no product investigation can be performed, and the customer complaint cannot be confirmed.A manufacturing record evaluation was performed for the finished device 31002442l number, and no non-conformances 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.This report is being submitted pursuant to the provisions of 21 cfr, part 803.This report may be based on information which has not been investigated or verified prior to the required reporting date.This report does not reflect a conclusion by biosense webster, inc., or its employees that the report constitutes an admission that the product, biosense webster, inc., or its employees caused or contributed to the potential event described in this report.If information is obtained that was not available for the initial report, a follow-up report will be filed as appropriate.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 32599
MX   32599
Manufacturer Contact
kate karberg
31 technology dr
irvine, CA 92618
3035526892
MDR Report Key17183202
MDR Text Key317737886
Report Number2029046-2023-01353
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,Health Professional
Reporter Occupation Physician
Type of Report Initial
Report Date 06/22/2023
1 Device was Involved in the Event
1 Patient was Involved in the Event
Date FDA Received06/22/2023
Is this an Adverse Event Report? Yes
Is this a Product Problem Report? No
Device Operator Health Professional
Device Model NumberD134805
Device Catalogue NumberD134805
Device Lot Number31002442L
Was Device Available for Evaluation? No
Is the Reporter a Health Professional? Yes
Date Manufacturer Received05/24/2023
Was Device Evaluated by Manufacturer? Device Not Returned to Manufacturer
Date Device Manufactured03/08/2023
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
SMARTABLATE GEN. KIT (JAPAN).
Patient Outcome(s) Hospitalization;
Patient Age81 YR
Patient SexFemale
Patient Weight40 KG
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