inforMED
InjuryNHW

REMINGTON

Received Jul 30, 2009 · Event occurred Jun 12, 2009

Report MW5012191 · MDR key 1431497

Device

Generic name

Disposable Extension Cable

Manufacturer

Remington Medical

Model number

UNK

Product problems

  • Break
  • Detachment Of Device Component

Patient

82 YR

  • Death

Narrative

Description of Event or Problem

PT S/P AVR, TEE ON CARDIOVASCULAR UNIT DEVELOPED HYPOTENSION AND BRADYCARDIA. PT'S EPICARDIAL PACING WIRES WERE ATTACHED TO TWO EXTENSION CABLES TO ATTEMPT TO PACE THE PT. ONE OF THE EXTENSION CABLES QUICK CONNECT TABS BROKE OFF; CABLE COULD NOT BE SECURED TO PACEMAKER. CABLES REPLACED WITH OTHER CABLES AND THERE WAS NO HARM TO THE PT, WHO WAS TRANSFERRED TO ICU AND EXPIRED LATER THAT EVENING FROM HER UNDERLYING DISEASE.