MAUDE Adverse Event Report: Medtronic Puerto Rico Villalba Screw-In Lead; PERMANENT PACEMAKER ELECTRODE

Model Number	5071-35
Medical Device Problem Code	Adverse Event Without Identified Device or Use Problem (2993)
Health Effect - Clinical Codes	Bacterial Infection (1735); Purulent Discharge (1812); Hematoma (1884); Bacteremia (4846)
Date of Event	07/15/2026
Type of Reportable Event	Serious Injury
Event or Problem Description
It was reported that the cardiac resynchronization therapy defibrillator (crt-d) patient developed an infection with the device and the leads.The patient was noted to have methicillin-sensitive staphylococcus aureus (mssa) bacteremia and purulent drainage/pus was noted around the crt-d.It was also noted there was an infected hematoma.The crt-d, right atrial (ra) lead and right ventricular (rv) lead were explanted along with a previously capped rv lead.The epicardial left ventricular (lv) lead and a redundant epicardial lv lead were cut and pulled down into the chest cavity and remain in the patient.Pocket debridement was performed and a drain was placed.The patient received temporary pacing until a leadless implantable pulse generator (ipg) was later implanted.No further patient complications have been reported as a result of this event.
Additional Manufacturer Narrative
Continuation of d10: 694765 lead, implanted: (b)(6) 2009.5076-52 lead, implanted: (b)(6) 2005.Medtronic submits this report to comply with fda regulations 21 cfr parts 4 and 803.Medtronic has made reasonable efforts to provide as much relevant information as is available to the company as of the submission date of this report.This report does not constitute an admission or a conclusion by fda, medtronic, or its employees that the device, medtronic, or its employee caused or contributed to the event described in the report.Any required fields that are unpopulated are blank because the information is currently unknown or unavailable.Medtronic will submit a supplemental report if additional relevant information becomes known.

• Brand Name: Screw-In Lead
• Common Device Name: PERMANENT PACEMAKER ELECTRODE
• Manufacturer (Section D): Medtronic Puerto Rico Villalba; road 149 km 56.3; villalba PR 00766
• Manufacturer (Section G): Medtronic Puerto Rico Villalba; road 149 km 56.3; villalba PR 00766
• Manufacturer Contact: gerard torenvliet ; 8200 coral sea st ne; mounds view, MN 55112--439 ; +1(763)526-9277
• MDR Report Key: 50350561
• Report Number: 2649622-2026-24672
• Device Sequence Number: 10103485
• Product Code: DTB
• UDI-Device Identifier: 00643169638594
• UDI-Public: (01)00643169638594(17)290506
• Combination Product (Y/N): N
• Initial Reporter State: AZ
• Initial Reporter Country: US
• PMA/510(K) Number: P120017
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2026
• Device Explanted Year: 2026
• Serviced by Third Party (Y/N): N
• Reporter Type: Manufacturer
• Report Source: Health Professional
• Initial Reporter Occupation: Physician
• Type of Report: Initial
• Report Date (Section B): 08/20/2026

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: Lay User/Patient
• Device Model Number: 5071-35
• Device Catalogue Number: 5071-35
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: Not provided
• Initial Report FDA Received Date: 08/20/2026
• Date Device Manufactured: 05/23/2025
• 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
• Concomitant Medical Products and Therapy/Usage Dates: 5071-35 LEAD, DTPA2D1 CRT-D
• Outcome Attributed to Adverse Event: Hospitalization; Required Intervention
• Patient Age: 85 YR
• Patient Sex: Female