FDA Adverse Event
Malfunction
Summary report: N
TENDRIL ST
MDR report key: 1955505
·
Received January 10, 2011
Report
- Report Number
- 2017865-2011-00869
- Event Type
- Malfunction
- Date Received
- January 10, 2011
- Date of Event
- October 18, 2010
- Manufacturer
- ST JUDE MEDICAL CARDIAC RHYTHM MANAGEMENT DIVISION
- Product Code
- DTB
- PMA / PMN Number
- P960013
- Removal / Correction Number
- NA
- Product Problem
- Yes
- Report Source
- Manufacturer report
- Reporter Location
- MN
- Reporter Occupation
- OTHER HEALTH CARE PROFESSIONAL
Narratives
Additional Manufacturer Narrative · 1
ALL INFORMATION PROVIDED BY MANUFACTURER, NO MEDWATCH FORM WAS RECEIVED.
Description of Event or Problem · 1
NEW INFORMATION ON (B)(6) 2014 INDICATES THE LEAD CONTINUED TO EXHIBIT NOISE WITH MODE SWITCH. THE LEAD WAS CAPPED ON (B)(6) 2014 DURING A ROUTINE GENERATOR CHANGE OUT. THE PATIENT HAD NO ADVERSE EVENT AND WAS DISCHARGED THE FOLLOWING DAY.
Description of Event or Problem · 1
IT WAS REPORTED THAT THE ATRIAL LEAD EXHIBITED NOISE.
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 | 1888TC/46 | NA |
Patients
| Seq | Age | Sex | Outcome | Treatment |
|---|---|---|---|---|
| 1 | 40 YR |