MAUDE Adverse Event Report: ST. JUDE MEDICAL, INC. REFLEXION SPIRAL¿ VARIABLE RADIUS CATHETER 6 F LOOP BI-DIRECTIONAL, 7F; CATHETER, ELECTRODE RECORDING, OR PROBE, ELECTRODE RECORDING

Model Number	402804
Medical Device Problem Codes	Difficult to Remove (1528); Material Separation (1562); Material Split, Cut or Torn (4008)
Health Effect - Clinical Code	No Consequences Or Impact To Patient (2199)
Date of Event	09/10/2019
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
The results/method and conclusion codes along with investigation results will be provided in a subsequent submission.
Event or Problem Description
During a pulmonary vein isolation procedure the catheter became stuck in the patient.While maneuvering the catheter in the right inferior pulmonary vein in the left atrium, a snap within the catheter handle was felt.Fluoroscopy was used to try to guide the catheter back into the introducer but it was not possible since the control wire was exposed.The catheter and introducer were removed as one unit to the insertion site.The handle of the catheter was cut in order to utilize short sheaths to safely retrieve the catheter.Once removed, contrast injection was used to check for any injury to the patient during catheter/introducer withdrawal with no trauma observed.
Additional Manufacturer Narrative
Additional information: g4, g7, h2, h3, h6; one duo-decapolar, bi-directional, variable radius, reflexion spiral catheter was received for evaluation.Upon visual inspection the spiral loop was noted to be fractured and detached at the spiral loop/shaft transition and the shaft was cut off at the distal strain relief.The device history record was reviewed to ensure that each manufacturing and inspection operation was performed.The cause of the damage to the catheter shaft and spiral loop is consistent with damage during use.

• Brand Name: REFLEXION SPIRAL¿ VARIABLE RADIUS CATHETER 6 F LOOP BI-DIRECTIONAL, 7F
• Common Device Name: CATHETER, ELECTRODE RECORDING, OR PROBE, ELECTRODE RECORDING
• Manufacturer (Section D): ST. JUDE MEDICAL, INC.; 14901 deveau place; minnetonka MN 55345
• MDR Report Key: 9124640
• Report Number: 2182269-2019-00169
• Device Sequence Number: 2323240
• Product Code: DRF
• UDI-Device Identifier: 05414734206204
• UDI-Public: 05414734206204
• Combination Product (Y/N): N
• Initial Reporter State: MS
• Initial Reporter Country: US
• PMA/510(K) Number: K062251
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: company representative,health
• Initial Reporter Occupation: Physician
• Type of Report: Initial,Followup
• Report Date (Section B): 01/07/2020

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Operator of Device: Health Professional
• Device Expiration Date: 03/31/2022
• Device Model Number: 402804
• Device Catalogue Number: 402804
• Device Lot Number: 6957661
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 09/23/2019
• Was the Report Sent to FDA?: No
• Initial Date Received by Manufacturer: 09/10/2019
• Supplement Date Received by Manufacturer: 12/19/2019
• Initial Report FDA Received Date: 09/26/2019
• Supplement Report FDA Received Date: 01/07/2020
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1
• Patient Age: 66 YR
• Patient Weight: 95