BEUDAMED
    FDA Adverse Event Injury Summary report: N

    MYOPORE® SUTURELESS MYOCARDIAL PACING LEAD

    MDR report key: 19384959 · Received May 23, 2024

    Report

    Report Number
    2183787-2024-00037
    Event Type
    Injury
    Date Received
    May 23, 2024
    Report Date
    May 6, 2024
    Manufacturer
    GREATBATCH MEDICAL
    Product Code
    DTB
    PMA / PMN Number
    P130012
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    US
    Reporter Occupation
    003

    Narratives

    Additional Manufacturer Narrative · 0

    UDI RELATED DATA QUALITY UPDATES ONLY** H2 : CORRECTION MARKED DIFFERENT UDIS WERE USED WHEN SKU 200988-XXX WAS MANUFACTURED. WHEN GREATBATCH (GBM) TRANSITIONED TO GS1- 128 BARCODES, THE GTIN FOR SKU 200988-XXX WAS ASSIGNED. THE GTIN IN THE GUDID DATABASE WILL NOT ALIGN WITH THE BARCODE. AS NEW GTINS WERE ASSIGNED WHEN GBM TRANSITIONED TO THE GUDID SYSTEM. CLASS III DEVICES WERE REQUIRED TO REGISTER GTINS IN THE GUDID DATABASE ON 01-JUN-2013; THEREFOR, THE UDI FIELD (D4) IN FORM 3500A WILL NOT ALIGN WITH THE GUDID. ENTRY DUE TO THE DATE IT WAS MANUFACTURED.

    Description of Event or Problem · 0

    LEAD WAS EXPLANTED DUE TO INFECTION.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    12732 MYOPORE® SUTURELESS MYOCARDIAL PACING LEAD BIPOLAR EPICARDIAL LEAD DTB GREATBATCH MEDICAL 511211 W50471

    Patients

    Seq Age Sex Outcome Treatment
    1 78 YR Female Required Intervention