BEUDAMED
    FDA Adverse Event Injury Summary report: N

    TENDRIL ST

    MDR report key: 1073296 · Received July 11, 2008

    Report

    Report Number
    2017865-2008-02095
    Event Type
    Injury
    Date Received
    July 11, 2008
    Date of Event
    May 15, 2008
    Manufacturer
    ST JUDE MEDICAL CARDIAC RHYTHM MANAGEMENT DIVISION
    Product Code
    DTB
    PMA / PMN Number
    NA
    Removal / Correction Number
    NA
    Report Source
    Manufacturer report
    Reporter Location
    LA
    Reporter Occupation
    OTHER HEALTH CARE PROFESSIONAL

    Narratives

    Additional Manufacturer Narrative · 1

    NO MEDWATCH FORM WAS RECEIVED. SYMPTOMATIC.

    Description of Event or Problem · 1

    THE PATIENT PRESENTED TO THE CLINIC ONE MONTH POST IMPLANT. SHE HAS BEEN FEELING SYMPTOMATIC SINCE FOUR DAYS AFTER IMPLANT. AN X-RAY REVEALED THAT THE ATRIAL LEAD HAD FALLEN.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 TENDRIL ST PERMANENT PACEMAKER ELECTRODE DTB ST JUDE MEDICAL CARDIAC RHYTHM MANAGEMENT DIVISION 1788TC/46 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 72 YR Required Intervention