BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    TENDRIL SCX

    MDR report key: 4144779 · Received January 13, 2014

    Report

    Report Number
    2017865-2014-06824
    Event Type
    Malfunction
    Date Received
    January 13, 2014
    Date of Event
    November 20, 2012
    Manufacturer
    ST. JUDE MEDICAL, CARDIAC RHYTHM MANAGEMENT DIVISI
    Product Code
    DTB
    PMA / PMN Number
    NA
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    IL, US
    Reporter Occupation
    PHYSICIAN

    Narratives

    Additional Manufacturer Narrative · 1

    ALL INFO PROVIDED BY MFR, NO MEDWATCH FORM WAS RECEIVED. 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 HAD DISLODGED AND EXHIBITED INCREASED CAPTURE THRESHOLD AND INTERMITTENT SENSING. THE LEAD WAS SCHEDULED TO BE REPOSITIONED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    29487 TENDRIL SCX PERMANENT PACEMAKER ELECTRODE DTB ST. JUDE MEDICAL, CARDIAC RHYTHM MANAGEMENT DIVISI 1688TC/52

    Patients

    Seq Age Sex Outcome Treatment
    1 59 YR