BEUDAMED
    FDA Adverse Event Injury Summary report: N

    RELIA S

    MDR report key: 1792500 · Received August 11, 2010

    Report

    Report Number
    6000094-2010-01486
    Event Type
    Injury
    Date Received
    August 11, 2010
    Date of Event
    April 29, 2010
    Manufacturer
    MEDTRONIC S.A.
    Product Code
    NVZ
    PMA / PMN Number
    P980035/S097
    Removal / Correction Number
    ASKU
    Report Source
    Manufacturer report
    Reporter Location
    BG
    Reporter Occupation
    PHYSICIAN

    Narratives

    Additional Manufacturer Narrative · 1

    THIS EVENT OCCURRED OUTSIDE THE US. ALL INFORMATION PROVIDED IS INCLUDED IN THIS REPORT. IF ADDITIONAL RELEVANT INFORMATION IS RECEIVED, A SUPPLEMENTAL REPORT WILL BE SUBMITTED. PATIENT INFORMATION IS NOT GENERALLY AVAILABLE DUE TO CONFIDENTIALITY CONCERNS. EVALUATION SUMMARY: (B)(4) NO ANOMALIES FOUND.

    Description of Event or Problem · 1

    IT WAS REPORTED THAT THE PATIENT COMPLAINED OF SYMPTOMS. UPON INTERROGATION OF THE DEVICE, THERE WAS COMPLETE CAPTURE FAILURE AND THE IMPLANTABLE PULSE GENERATOR WAS NOT WORKING EVEN WHEN ALL PARAMETERS WERE CHECKED. THE DEVICE WAS EXPLANTED AND REPLACED. NO PATIENT COMPLICATIONS HAVE BEEN REPORTED AS A RESULT OF THIS EVENT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 RELIA S IMPLANTABLE PULSE GENERATOR NVZ MEDTRONIC S.A. RES01 ASKU

    Patients

    Seq Age Sex Outcome Treatment
    1 Required Intervention