FDA Adverse Event
Injury
Summary report: N
TENDRIL ST
MDR report key: 2240295
·
Received September 9, 2011
Report
- Report Number
- 2017865-2011-05745
- Event Type
- Injury
- Date Received
- September 9, 2011
- Date of Event
- July 9, 2011
- Manufacturer
- ST JUDE MEDICAL CARDIAC RHYTHM MANAGEMENT DIVISION
- Product Code
- NVN
- PMA / PMN Number
- P960013
- Removal / Correction Number
- NA
- Adverse Event
- Yes
- Product Problem
- Yes
- Report Source
- Manufacturer report
- Reporter Location
- PA
- 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
IT WAS REPORTED THAT THE PATIENT PRESENTED TO THE EMERGENCY ROOM WITH A COUGH AND DIFFICULTY BREATHING. AN ECG SHOWED A SMALL PLEURAL EFFUSION. THERE WAS NO CAPTURE AT MAXIMUM OUTPUT. R WAVE AMPLITUDE DECREASED TO 0.5 MV. FURTHER EVALUATION OF THE PATIENT WAS PLANNED.
Description of Event or Problem · 1
NEW INFORMATION NOTES THAT THE LEAD WAS EXPLANTED ON (B)(6) 2013 AND REPLACED.
Devices
| Seq | Brand | Generic | Product Code | Manufacturer | Model | Lot | UDI-DI |
|---|---|---|---|---|---|---|---|
| 1 | TENDRIL ST | PERMANENT PACEMAKER ELECTRODE | NVN | ST JUDE MEDICAL CARDIAC RHYTHM MANAGEMENT DIVISION | 1888TC/58 | NA |
Patients
| Seq | Age | Sex | Outcome | Treatment |
|---|---|---|---|---|
| 1 | 71 YR | Required Intervention |