MAUDE MDR 1626174

MDR report key
1626174
Report number
3003870001-2010-00001
Event key
0
Event type
3
Date of event
2009-11-03
Date received
2010-03-08
Adverse event
3
Product problem
3
Patients in event
0
Reporter occupation
0
Health professional
3
Initial report to FDA
3
Event location
3

Manufacturer Contact#

Contact
SETH KERSTEN
Address
ONE ST. JUDE MEDICAL DR ST. PAUL MN 55117 US
Phone
651-651-6517
Report source
M
Manufacturer link flag
Y

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1ABLATION CONTROL SYSTEMABLATION CONTROL SYSTEMST. JUDE MEDICALNTBNA11773NAR N

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12010-03-0801. H; 2. R

Event Narratives#

D

Patient 1

A MEDWATCH REPORT WAS RECEIVED FROM THE HOSPITAL STATING THE PT HAD A SURGICAL CARDIAC ABLATION USING AN ULTRACINCH AND ULTRAWAND DEVICE. FLUOROSCOPIC GUIDANCE WAS USED DURING THE PROCEDURE, WHICH CONFIRMED THE WAND AND THE CINCH WERE CORRECTLY PLACED. A TRANSESOPHAGEAL ECHO (TEE) HAD BEEN PERFORMED. THE PT EXPERIENCED DIFFICULTIES SWALLOWING POST OP AND WAS RE ADMITTED. A SWALLOW EXAM REVEALED EVIDENCE OF A LOCALIZED ESOPHAGEAL PERFORATION. A FEEDING THE TUBE WAS PLACED AND THE PHYSICIAN INDICATED THEY LET THE ESOPHAGUS REST. THE PT DID NOT REQUIRE SURGERY AND HAS FULLY RECOVERED. THE PHYSICIAN STATED HE DID NOT FEEL ANY OF THE EPICOR DEVICES CONTRIBUTED TO THE REPORTED EVENT. THE ULTRAWAND AND ULTRACINCH (UNK REORDER AND LOT) DEVICES ARE NOT AVAILABLE FOR EVALUATION.

N

Patient 1

NONE OF THE COMPONENTS USED DURING THE PROCEDURE WERE RETURNED FOR EVALUATION. REVIEW OF THE DEVICE HISTORY RECORD CONFIRMED THIS DEVICE MET MANUFACTURING REQUIREMENTS PRIOR TO SHIPMENT. THE CAUSE FOR THE REPORTED TRANSESOPHAGEAL PERFORATION REMAINS UNK. THE PHYSICIAN STATED HE DID NOT FEEL ANY OF THE EPICOR DEVICES CONTRIBUTED TO THE REPORTED EVENT. DATE THE INITIAL REPORTER PROVIDED THE INFORMATION TO THE MANUFACTURER: 2/10/2010.