FDA Adverse Event
Injury
Summary report: N
TENDRIL STS
MDR report key: 4231441
·
Received November 6, 2014
Report
- Report Number
- 2017865-2014-18203
- Event Type
- Injury
- Date Received
- November 6, 2014
- Date of Event
- September 30, 2014
- Manufacturer
- ST. JUDE MEDICAL, INC., CRMD
- Product Code
- NVN
- PMA / PMN Number
- NA
- Removal / Correction Number
- NA
- Adverse Event
- Yes
- Product Problem
- Yes
- Report Source
- Manufacturer report
- Reporter Location
- KY, US
- Reporter Occupation
- PHYSICIAN
Narratives
Additional Manufacturer Narrative · 1
ALL INFORMATION PROVIDED BY MANUFACTURER, NO MEDWATCH FORM WAS RECEIVED.
Description of Event or Problem · 1
IT WAS REPORTED THE RIGHT VENTRICULAR LEAD EXHIBITED LOSS OF CAPTURE AT MAXIMUM OUTPUT, INCREASED THRESHOLDS AND DECREASED IMPEDANCE. A CHEST X-RAY CONFIRMED THAT THE LEAD WAS DISLODGED. THE LEAD WAS SUCCESSFULLY REPOSITIONED. THE PATIENT WOULD CONTINUE TO BE MONITORED.
Devices
| Seq | Brand | Generic | Product Code | Manufacturer | Model | Lot | UDI-DI |
|---|---|---|---|---|---|---|---|
| 714017 | TENDRIL STS | PERMANENT PACEMAKER ELECTRODE | NVN | ST. JUDE MEDICAL, INC., CRMD | 2088TC/52 | NA |
Patients
| Seq | Age | Sex | Outcome | Treatment |
|---|---|---|---|---|
| 1 | 74 YR | Required Intervention |