BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    CAPSUREFIX NOVUS

    MDR report key: 1924519 · Received December 14, 2010

    Report

    Report Number
    2649622-2010-13597
    Event Type
    Malfunction
    Date Received
    December 14, 2010
    Date of Event
    September 29, 2010
    Manufacturer
    MEDTRONIC PUERTO RICO, INC.
    Product Code
    DTB
    PMA / PMN Number
    P930039/S017
    Removal / Correction Number
    ASKU
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    NO
    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. (B)(4) NO ANOMALIES WERE FOUND; FULL LEAD WAS RETURNED AND ANALYZED. THE LEAD WAS NOT IN THE PACKAGING AT THE TIME OF THE ANALYSIS.

    Description of Event or Problem · 1

    IT WAS REPORTED THAT AT IMPLANT, THE PHYSICIAN NOTICED THE SEAL OF THE LEAD PACKAGING WAS LOOSE, AND FEARED THAT THE STERILITY MAY HAVE BEEN COMPROMISED. THE LEAD WAS NOT USED. NO PATIENT COMPLICATIONS WERE 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. 4076 ASKU

    Patients

    Seq Age Sex Outcome Treatment
    1 Other