MAUDE Adverse Event Report: MEDTRONIC CRYOCATH LP ACHIEVE MAPPING CATHETER; CATHETER, ELECTRODE RECORDING, OR PROBE, ELECTRODE RECORDING

Model Number 990063-020

Device Problem Temperature Problem (3022)

Patient Problem Pericardial Effusion (3271)

Event Date 09/17/2015

Event Type  Injury  

Manufacturer Narrative

The information submitted reflects all relevant data received.If additional relevant information is received, a supplemental report will be submitted.(b)(4.).

Event Description

It was reported that during a cryoablation procedure, a system notice was received indicating that the safety system detected a compromised outer vacuum.The catheter and coaxial umbilical cable were changed which resolved this issue.Additionally, a system notice was received indicating that the system detected a temperature drop during the system flush, and the system flush was stopped.The cryoconsole unit was rebooted without resolve.It was confirmed that the healthcare professionals were using a saline/contrast flush and that the temperature was reading 31.The healthcare professional was instructed to hold off on the flush and they were able to pass the integrity test.The cryoconsole unit appeared to be functioning normally at that time of the first ablation.The case was then aborted due to a pericardial effusion noted on intracardiac ultrasound.No further patient complications have been reported as a result of this event.

Manufacturer Narrative

Product event summary: data file analysis was performed.The mapping catheter (b)(4) was not returned for analysis.There was an adverse event that was encountered during the procedure.In conclusion, an adverse event occurred during procedure (pericardial effusion) and the mapping catheter was not returned for analysis.

• Brand Name: ACHIEVE MAPPING CATHETER
• Type of Device: CATHETER, ELECTRODE RECORDING, OR PROBE, ELECTRODE RECORDING
• Manufacturer (Section D): MEDTRONIC CRYOCATH LP; 16771 chemin ste-marie; kirkland H9H 5 H3; CA H9H 5H3
• Manufacturer (Section G): MEDTRONIC CARDIAC RHYTHM HEART FAILURE; 8200 coral sea st ne; mounds view MN 55112
• Manufacturer Contact: anne schilling ; 8200 coral sea st ne; mounds view, MN 55112 ; 7635052036
• MDR Report Key: 5144895
• MDR Text Key: 28045730
• Report Number: 3002648230-2015-00354
• Device Sequence Number: 1
• Product Code: DRF
• Combination Product (y/n): N
• Reporter Country Code: US
• PMA/PMN Number: K102588
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: company representative,health
• Reporter Occupation: Other
• Type of Report: Followup
• Report Date: 09/17/2015

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 10/13/2015
• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: No
• Device Operator: Health Professional
• Device Model Number: 990063-020
• Device Catalogue Number: 990063-020
• Device Lot Number: UNKNOWN
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: No
• Date Manufacturer Received: 09/17/2015
• Was Device Evaluated by Manufacturer?: Yes
• Is the Device Single Use?: Yes
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: Initial
• Patient Sequence Number: 1
• Patient Outcome(s): Hospitalization; Life Threatening; Required Intervention