FDA Adverse Event Injury Summary report: N

TENDRIL ST

MDR report key: 2983842 · Received February 28, 2013

Report

Report Number
2017865-2013-01508
Event Type
Injury
Date Received
February 28, 2013
Date of Event
December 19, 2012
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 Occupation
OTHER HEALTH CARE PROFESSIONAL

Narratives

Additional Manufacturer Narrative · 1

NO MEDWATCH FORM WAS RECEIVED.

Description of Event or Problem · 1

IT WAS REPORTED THAT THE RIGHT VENTRICULAR LEAD EXHIBITED LOSS OF SENSING, HIGH THRESHOLDS DUE TO DISLODGEMENT. THE PATIENT EXPERIENCED TWIDDLER'S SYNDROME. THE LEAD WAS EXPLANTED AND REPLACED.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
87959 TENDRIL ST PERMANENT PACEMAKER ELECTRODE NVN ST JUDE MEDICAL CARDIAC RHYTHM MANAGEMENT DIVISION 1888TC/58 NA

Patients

Seq Age Sex Outcome Treatment
1 86 YR Required Intervention