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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: CARDIOFOCUS HEARTLIGHT; HEARTLIGHT CATHETER
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CARDIOFOCUS HEARTLIGHT; HEARTLIGHT CATHETER Back to Search Results
Model Number 18-2531-N250
Medical Device Problem Code Adverse Event Without Identified Device or Use Problem (2993)
Health Effect - Clinical Code Nerve Damage (1979)
Date of Event 11/04/2020
Type of Reportable Event Serious Injury
Additional Manufacturer Narrative
No device deficiency reported.Phrenic nerve injury leading to diaphragmatic paralysis is a known potential adverse event for catheter ablation procedures disclosed in product labeling.
 
Event or Problem Description
During a pulmonary vein isolation (pvi) procedure to treat atrial fibrillation diaphragmatic capture was lost during ablation of the right superior pulmonary vein (rspv).Loss of right side diaphragmatic motion was confirmed with fluoroscopy.No additional information on this event is available.
 
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Brand Name
HEARTLIGHT
Common Device Name
HEARTLIGHT CATHETER
Manufacturer (Section D)
CARDIOFOCUS
500 nickerson rd.
suite 500-200
marlboro MA 01752
MDR Report Key10936513
Report Number1225698-2020-00032
Device Sequence Number4295336
Product Code OAE
UDI-Device Identifier00868976000109
UDI-Public00868976000109
Combination Product (Y/N)N
Initial Reporter CountryJA
PMA/510(K) Number
P150026
Number of Events Summarized1
Summary Report (Y/N)N
Serviced by Third Party (Y/N)Unknown
Reporter Type Manufacturer
Report Source company representative,foreig
Initial Reporter Occupation Physician
Type of Report Initial
Report Date (Section B) 12/02/2020
1 Device was Involved in the Event
1 Patient was Involved in the Event
Is this an Adverse Event Report? Yes
Is this a Product Problem Report? No
Operator of Device Health Professional
Device Expiration Date05/31/2021
Device Model Number18-2531-N250
Device Catalogue Number18-2531-N250
Device Lot Number12572-002
Type of Report(Section G)Thirty-Day
Initial Date Received by Manufacturer 11/04/2020
Initial Report FDA Received Date12/02/2020
Is This a Single-Use Device that was
Reprocessed and Reused on a Patient? (Y/N)		 No
Patient Sequence Number1
Outcome Attributed to Adverse Event Other;
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