BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    TENDRIL ST

    MDR report key: 4143318 · Received January 13, 2014

    Report

    Report Number
    2017865-2014-05774
    Event Type
    Malfunction
    Date Received
    January 13, 2014
    Date of Event
    October 26, 2012
    Manufacturer
    ST. JUDE MEDICAL INC. CRMD
    Product Code
    DTB
    PMA / PMN Number
    NA
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CO, US
    Reporter Occupation
    PHYSICIAN

    Narratives

    Additional Manufacturer Narrative · 1

    THIS HISTORICAL COMPLAINT IS BEING FILED AS PART OF A RETROSPECTIVE REVIEW OF COMPLAINT FILES IN RESPONSE TO A RECENT FDA INSPECTION. THERE IS NO CHANGE TO THE ACTUAL PERFORMANCE OF THE PRODUCT AND THIS REPORT ONLY REPRESENTS AN ENHANCEMENT TO THE REPORTING CRITERIA GOING FORWARD.

    Description of Event or Problem · 1

    IT WAS REPORTED THAT THE RIGHT ATRIAL LEAD DISLODGED AND EXHIBITED LOSS OF CAPTURE AFTER IMPLANT. THE LEAD WAS SCHEDULED TO BE REPOSITIONED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    28573 TENDRIL ST PERMANENT PACEMAKER ELECTRODE DTB ST. JUDE MEDICAL INC. CRMD 1882TC/52

    Patients

    Seq Age Sex Outcome Treatment
    1 66 YR