MAUDE Adverse Event Report: MEDTRONIC CRYOCATH LP FLEXCATH ADVANCE STEERABLE SHEATH; CATHETER, STEERABLE

Model Number	4FC12
Medical Device Problem Code	Adverse Event Without Identified Device or Use Problem (2993)
Health Effect - Clinical Codes	Arrhythmia (1721); Atrial Fibrillation (1729); Dyspnea (1816); Low Blood Pressure/ Hypotension (1914)
Date of Event	03/02/2025
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
Medtronic submits this report to comply with fda regulations 21 cfr parts 4 and 803.Medtronic has made reasonable efforts to provide as much relevant information as is available to the company as of the submission date of this report.This report does not constitute an admission or a conclusion by fda, medtronic, or its employees that the device, medtronic, or its employee caused or contributed to the event described in the report.Any required fields that are unpopulated are blank because the information is currently unknown or unavailable.Medtronic will submit a supplemental report if additional relevant information becomes known.
Event or Problem Description
It was reported that after a cryo ablation procedure, post-procedure the patient experienced several adverse events.Post procedure the patient exhibited inflammation due to pericarditis.The patient later presented to the emergency department (ed) with tachycardia arriving with a heart rate in the 140s.The patient was mildly hypotensive.The patient was placed on a saline bolus and a calcium blocker medication was administered.The patient was electrically cardioverted to normal sinus rhythm and discharged from the ed.Two days later the patient returned to the ed with irregular heartbeat in the 130s and 140s.The patient as examined and it was observed that the patient had a distinctly regular rhythm with rapid heartbeat.An electrocardiogram (ekg) test confirmed atrial fibrillation with rapid ventricular response.Prior to administration of a calcium blocker, the patient returned to normal sinus rhythm and was discharged home.Three days later the patient returned to the ed with palpitations and shortness of breath.A beta blocker was administered to the patient without resolution for the atrial fibrillation.Antiarrhythmic medication was administered to the patient.The patient had been to the emergency room (er) twice in the past week for cardioversion treatment.The patient was then admitted to hospital for observation.The patient was later cardioverted to normal sinus rhythm and discharged from the ed.The patient later recovered.No further patient complications have been reported as a result of this event.

• Brand Name: FLEXCATH ADVANCE STEERABLE SHEATH
• Common Device Name: CATHETER, STEERABLE
• Manufacturer (Section D): MEDTRONIC CRYOCATH LP; 9000 autoroute transcanadienne; pointe-claire,qc H9R 5 Z8; CA H9R 5Z8
• Manufacturer (Section G): MEDTRONIC CRYOCATH LP; 9000 autoroute transcanadienne; pointe-claire,qc H9R 5 Z8; CA H9R 5Z8
• Manufacturer Contact: alison sweeney ; parkmore business park west; galway ; EI ; 091708096
• MDR Report Key: 21773670
• Report Number: 3002648230-2025-00277
• Device Sequence Number: 15475589
• Product Code: DRA
• UDI-Device Identifier: 00763000418052
• UDI-Public: 00763000418052
• Combination Product (Y/N): N
• Initial Reporter State: OH
• Initial Reporter Country: US
• PMA/510(K) Number: K123591
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): N
• Reporter Type: Manufacturer
• Report Source: Study,Health Professional,Company Representative
• Initial Reporter Occupation: Physician
• Type of Report: Initial
• Report Date (Section B): 04/04/2025

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 Model Number: 4FC12
• Device Catalogue Number: 4FC12
• Device Lot Number: 0012615894
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 03/17/2025
• Initial Report FDA Received Date: 04/04/2025
• Date Device Manufactured: 01/17/2025
• Is the Device Labeled for Single Use? (Y/N): Yes
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Usage of Device: Initial
• Patient Sequence Number: 1
• Outcome Attributed to Adverse Event: Required Intervention; Hospitalization
• Patient Age: 72 YR
• Patient Sex: Male
• Patient Weight: 75 KG