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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: ST. JUDE MEDICAL BRK-1¿ TRANSSEPTAL NEEDLE, 98 CM LENGTH

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ST. JUDE MEDICAL BRK-1¿ TRANSSEPTAL NEEDLE, 98 CM LENGTH Back to Search Results
Model Number 407207
Device Problem Adverse Event Without Identified Device or Use Problem (2993)
Patient Problem Cardiac Perforation (2513)
Event Date 10/19/2016
Event Type  Injury  
Manufacturer Narrative
(b)(4).The results of the investigation are inconclusive since the device was not returned for analysis.Our investigation was limited to the review of the device history record, which showed that each manufacturing and inspection operation was performed and indicated complete in accordance with sjm specifications and procedures.Based on the information received, the cause of the reported pericardial effusion was procedure related.Per the ifu, cardiac perforation is a known risk during the use of this device.
 
Event Description
Related manufacturer: 3008452825-2016-00156, 2182269-2016-00024, 2182269-2016-00025.During a ventricular tachycardia ablation procedure a pericardial effusion occurred.A quadripolar catheter was placed in the right ventricular apex and transseptal access was performed.Geometry of the left ventricle was created and ablation was performed.For a short time, the ablation catheter appeared outside of the geometry and further lesions were completed in the left ventricle.The patient became hypotensive and a pericardial effusion was noted via intracardiac echocardiogram, for which a pericardiocentesis was performed to stabilize the patient.There were no performance issues with any sjm device during the procedure.
 
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Brand Name
BRK-1¿ TRANSSEPTAL NEEDLE, 98 CM LENGTH
Type of Device
TRANSSEPTAL NEEDLE
Manufacturer (Section D)
ST. JUDE MEDICAL
parque industrial, zona franca coyol s.a.
edificio #44b, calle 0, avenida 2, coyol
alajuela, costa rica 1897- 4050
CS  1897-4050
Manufacturer (Section G)
ST. JUDE MEDICAL
parque industrial, zona franca coyol s.a.
edificio #44b, calle 0, avenida 2, coyol
alajuela, costa rica 1897- 4050
CS   1897-4050
Manufacturer Contact
denise johnson
5050 nathan lane north
plymouth, MN 55442
6517564470
MDR Report Key6105709
MDR Text Key59993287
Report Number3008452825-2016-00157
Device Sequence Number1
Product Code DRC
Combination Product (y/n)N
Reporter Country CodeUS
PMA/PMN Number
K072278
Number of Events Reported1
Summary Report (Y/N)N
Report Source Manufacturer
Source Type company representative,health
Reporter Occupation Physician
Type of Report Initial
Report Date 10/19/2016
1 Device was Involved in the Event
1 Patient was Involved in the Event
Date FDA Received11/16/2016
Is this an Adverse Event Report? Yes
Is this a Product Problem Report? No
Device Operator Health Professional
Device Expiration Date06/30/2019
Device Model Number407207
Device Lot Number5566522
Was Device Available for Evaluation? No
Is the Reporter a Health Professional? Yes
Date Manufacturer Received10/19/2016
Was Device Evaluated by Manufacturer? Device Not Returned to Manufacturer
Date Device Manufactured07/12/2016
Is the Device Single Use? Yes
Is This a Reprocessed and Reused Single-Use Device? No
Type of Device Usage Initial
Patient Sequence Number1
Treatment
AGILIS INTRODUCER; FLEXABILITY CATHETER; LIVEWIRE CATHETER; VIEWFLEX ICE CATHETER
Patient Outcome(s) Required Intervention;
Patient Age73 YR
Patient Weight70
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