BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    CAPSUREFIX NOVUS

    MDR report key: 1862814 · Received October 9, 2010

    Report

    Report Number
    2649622-2010-10409
    Event Type
    Malfunction
    Date Received
    October 9, 2010
    Date of Event
    July 16, 2010
    Manufacturer
    MEDTRONIC PUERTO RICO, INC.
    Product Code
    DTB
    PMA / PMN Number
    P930039/S009
    Removal / Correction Number
    ASKU
    Report Source
    Manufacturer report
    Reporter Location
    IL, US
    Reporter Occupation
    HEALTH PROFESSIONAL

    Narratives

    Additional Manufacturer Narrative · 1

    THE INFORMATION SUBMITTED REFLECTS ALL RELEVANT DATA RECEIVED. IF ADDITIONAL RELEVANT INFORMATION IS RECEIVED, A SUPPLEMENTAL REPORT WILL BE SUBMITTED.

    Description of Event or Problem · 1

    IT WAS REPORTED THAT OVERSENSING WAS BEING SEEN ON BOTH THE A AND V LEADS. IT WAS ALSO REPORTED THAT THERE WAS A SMALL DECREASE IN IMPEDANCE AND INCREASE IN CAPTURE THRESHOLD ON THE V LEAD. BOTH THE A AND V LEADS WERE CAPPED LESS THAN A WEEK LATER AND NEW LEADS WERE IMPLANTED. THERE WERE NO PATIENT COMPLICATIONS REPORTED AS A RESULT OF THIS EVENT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 CAPSUREFIX NOVUS IMPLANTABLE PACING LEAD DTB MEDTRONIC PUERTO RICO, INC. 5076 ASKU

    Patients

    Seq Age Sex Outcome Treatment
    1 65 YR Required Intervention 5071 IMPLANTABLE PACING LEAD| E2DR01AA IMPLANTABLE PACEMAKER