BEUDAMED
    FDA Adverse Event Injury Summary report: N

    TENDRIL ST

    MDR report key: 4191781 · Received January 13, 2014

    Report

    Report Number
    2017865-2014-04597
    Event Type
    Injury
    Date Received
    January 13, 2014
    Date of Event
    October 25, 2012
    Manufacturer
    ST. JUDE MEDICAL, CRMD
    Product Code
    NVN
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CH
    Reporter Occupation
    PHYSICIAN

    Narratives

    Additional Manufacturer Narrative · 1

    ALL INFORMATION PROVIDED BY MANUFACTURER, 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. EVALUATION DESCRIPTION: ANALYSIS WAS NORMAL. NO ANOMALY WAS FOUND.

    Description of Event or Problem · 1

    IT WAS REPORTED THAT THE LEAD BECAME DISLODGED AND IT WAS REPOSITIONED SUCCESSFULLY. THE LEAD BECAME DISLODGED ONCE MORE AND THE PHYSICIAN DECIDED TO EXPLANT. THE LEAD WAS REPLACED ON THE LEFT SIDE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    28296 TENDRIL ST PERMANENT PACEMAKER ELECTRODE NVN ST. JUDE MEDICAL, CRMD 1888TC/52

    Patients

    Seq Age Sex Outcome Treatment
    1 Required Intervention