BEUDAMED
    FDA Adverse Event Injury Summary report: N

    PASSIVE PLUS

    MDR report key: 1896731 · Received November 10, 2010

    Report

    Report Number
    2017865-2010-04876
    Event Type
    Injury
    Date Received
    November 10, 2010
    Date of Event
    July 7, 2010
    Manufacturer
    ST JUDE MEDICAL CARDIAC RHYTHM MANAGEMENT DIVISION
    Product Code
    DTB
    PMA / PMN Number
    NA
    Removal / Correction Number
    NA
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    UT
    Reporter Occupation
    OTHER HEALTH CARE PROFESSIONAL

    Narratives

    Additional Manufacturer Narrative · 1

    ALL INFORMATION PROVIDED BY MANUFACTURER, NO MEDWATCH FORM WAS RECEIVED. REVIEW OF QUALITY RECORDS.

    Description of Event or Problem · 1

    IT WAS REPORTED THAT THE PATIENT DEVELOPED A POCKET INFECTION. THE LEAD WAS REMOVED AND REPLACED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 PASSIVE PLUS PERMANENT PACEMAKER ELECTRODE DTB ST JUDE MEDICAL CARDIAC RHYTHM MANAGEMENT DIVISION 1342T/46 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 82 YR Required Intervention 5810, (B)(4), 1336T/58, (B)(4)