BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    TENDRIL STS

    MDR report key: 4193586 · Received January 13, 2014

    Report

    Report Number
    2017865-2014-04171
    Event Type
    Malfunction
    Date Received
    January 13, 2014
    Date of Event
    June 1, 2011
    Manufacturer
    ST. JUDE MEDICAL, CRMD
    Product Code
    DTB
    PMA / PMN Number
    NA
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    JA
    Reporter Occupation
    PHYSICIAN

    Narratives

    Additional Manufacturer Narrative · 1

    ALL INFO WAS 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. EVAL DESCRIPTION: ANALYSIS REVEALED FRACTURE CONNECTOR PIN. THE APPEARANCE OF THE FRACTURE AREA INDICATES THAT THE CONNECTOR PIN HAS BEEN BENT AND STRAIGHTENED PERHAPS MORE THAN ONCE. THE ORIGIN OF THE BENDING COULD NOT BE DETERMINED. POSSIBLE CAUSES INCLUDE MFG AND IMPLANT DAMAGE. ELECTRICAL ANALYSIS INDICATED OPEN CIRCUIT DUE TO FRACTURED CONNECTOR PIN.

    Description of Event or Problem · 1

    IT WAS REPORTED THAT THE LEAD BECAME KINKED DURING IMPLANT. THE LEAD WAS REMOVED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    29581 TENDRIL STS PERMANENT PACEMAKER ELECTRODE DTB ST. JUDE MEDICAL, CRMD 2088TC/58

    Patients

    Seq Age Sex Outcome Treatment
    1