MAUDE Adverse Event Report: ST. JUDE MEDICAL BRK-1¿ TRANSSEPTAL NEEDLE, 71 CM LENGTH; TROCAR

Model Number	407201
Medical Device Problem Code	Adverse Event Without Identified Device or Use Problem (2993)
Health Effect - Clinical Code	Cardiac Perforation (2513)
Date of Event	01/25/2022
Type of Reportable Event	Serious Injury
Event or Problem Description
During an atrial fibrillation procedure, a perforation occurred during the transseptal puncture near the fossa ovalis.Moreover, when attempting the transseptal puncture, a high amount of resistance was felt and the tissue became colored with contrast.The patient then became hypotensive and a pericardial effusion was diagnosed via transthoracic echocardiogram.The procedure was then cancelled and heparin was administered to the patient.The patient remained stable and no pericardiocentesis was performed.The patient was then sent to the intensive care unit for monitoring.There were no performance issues with the abbott device.
Additional Manufacturer Narrative
Correction: h6.
Additional Manufacturer Narrative
Correction: h6 (health effect - impact code).
Additional Manufacturer Narrative
Additional information: d9, g3, h2, h3, h6.One brk transseptal needle/stylet assembly were received for evaluation.Functional testing revealed no resistance or functional anomalies were noted when the returned brk needle/stylet assembly was advanced through a dilator/sheath assembly from current inventory.The device history record was reviewed to ensure that each manufacturing and inspection operation was performed.The cause of the reported cardiac perforation remains unknown.Per the ifu, cardiac perforation is a known risk during the use of this device.

• Brand Name: BRK-1¿ TRANSSEPTAL NEEDLE, 71 CM LENGTH
• Common Device Name: TROCAR
• 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: janna parks ; 5050 nathan lane north; plymouth, MN 55442 ; 6517565400
• MDR Report Key: 13385214
• Report Number: 3008452825-2022-00030
• Device Sequence Number: 13914142
• Product Code: DRC
• UDI-Device Identifier: 05414734205160
• UDI-Public: 05414734205160
• Combination Product (Y/N): N
• Initial Reporter Country: SP
• PMA/510(K) Number: K072278
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): Unknown
• Reporter Type: Manufacturer
• Report Source: Foreign,Health Professional,Company Representative
• Initial Reporter Occupation: Physician
• Type of Report: Initial,Followup,Followup,Followup
• Report Date (Section B): 03/08/2022

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: No
• Operator of Device: Health Professional
• Device Expiration Date: 08/31/2024
• Device Model Number: 407201
• Device Catalogue Number: 407201
• Device Lot Number: 8150606
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 02/16/2022
• Is the Reporter a Health Professional?: Yes
• Was the Report Sent to FDA?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 01/28/2022
• Supplement Date Received by Manufacturer: 01/28/2022; 02/04/2022; 03/08/2022
• Initial Report FDA Received Date: 01/28/2022
• Supplement Report FDA Received Date: 01/28/2022; 02/04/2022; 03/08/2022
• Was Device Evaluated by Manufacturer? (Y/N): Yes
• Date Device Manufactured: 09/24/2021
• Is the Device Labeled for Single Use? (Y/N): Yes
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Usage of Device: Initial
• Patient Sequence Number: 1
• Outcome Attributed to Adverse Event: Other
• Patient Age: 68 YR
• Patient Sex: Female
• Patient Weight: 55 KG