BEUDAMED
    FDA Adverse Event Injury Summary report: N

    DEXTRUS 4136

    MDR report key: 1882349 · Received October 22, 2010

    Report

    Report Number
    1028232-2010-02217
    Event Type
    Injury
    Date Received
    October 22, 2010
    Date of Event
    July 22, 2010
    Report Date
    September 24, 2010
    Manufacturer
    BIOTRONIK SE & CO., KG
    Product Code
    NVZ
    PMA / PMN Number
    P950037
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    GM
    Reporter Occupation
    NOT APPLICABLE

    Narratives

    Additional Manufacturer Narrative · 1

    THE DEVICE WAS NOT RETURNED FOR ANALYSIS. THE ANALYSIS IS THEREFORE BASED ON THE INSPECTION OF THE QUALITY DOCUMENTS ACCOMPANYING THIS PARTICULAR DEVICE. THE MFG PROCESS FOR THIS DEVICE WAS RE-INVESTIGATED. ALL PRODUCTION STEPS HAD BEEN PERFORMED ACCORDINGLY. THERE WAS NO SIGN OF ANY INCONSISTENCY DURING THE MFG PROCESS, WHICH MIGHT BE RELATED TO THE CLINICAL OBSERVATION. IN SUMMARY, THE DEVICE WAS NOT RETURNED FOR ANALYSIS. THE REVIEW OF THE QUALITY DOCUMENTS CONFIRMED A REGULAR DEVICE MFG.

    Description of Event or Problem · 1

    BOSTON SCIENTIFIC CRM RECEIVED INFO THAT THE PATIENT WITH THIS RIGHT VENTRICULAR LEAD FELT DIZZY AFTER THE INITIAL IMPLANT PROCEDURE. IT WAS DETERMINED THAT BOTH LEADS WERE LOOSE AND A PROCEDURE WAS PERFORMED TO RECONNECT THE LEADS. SINCE THAT PROCEDURE, THE PT HAS FELT DIZZY AND EXPERIENCED CHEST PAIN. THIS LEAD REMAINS IMPLANTED. AS A RESULT, BOSTON SCIENTIFIC CRM IS UNABLE TO CONFIRM THE CLINICAL OBSERVATIONS. NO ADD'L INFO IS AVAILABLE AT THIS TIME. THIS EVENT WILL BE REOPENED IF ANY ADD'L INFO IS RECEIVED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 DEXTRUS 4136 PACER LEAD NVZ BIOTRONIK SE & CO., KG 358754

    Patients

    Seq Age Sex Outcome Treatment
    1 UNK Hospitalization