BEUDAMED
    FDA Adverse Event Injury Summary report: N

    CONSULTA

    MDR report key: 1991298 · Received February 15, 2011

    Report

    Report Number
    6000144-2011-00864
    Event Type
    Injury
    Date Received
    February 15, 2011
    Date of Event
    November 5, 2010
    Manufacturer
    MEDTRONIC MED REL, INC.
    Product Code
    NIK
    PMA / PMN Number
    P010031/S084
    Removal / Correction Number
    ASKU
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    KY, US
    Reporter Occupation
    PATIENT

    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 PATIENT SAID SHE HEARD "BEEPING" FROM THE DEVICE ONE DAY POST IMPLANT. SHE SAID SHE WENT INTO THE EMERGENCY ROOM TO HAVE THE DEVICE TESTED AND THE MEDTRONIC TECH SAID THE DEVICE "KEPT FIRING". THE PATIENT SAID SHE DID NOT RECEIVE ANY SHOCKS AND WAS NOT IN PAIN OR UNCOMFORTABLE. SHE SAID THEY TOLD HER A "SCREW WAS LOOSE" AND THE DOCTOR WASN'T ABLE TO GET HER IN FOR SURGERY TO HAVE IT FIXED. SHE SAID THE DEVICE WAS "DEFECTIVE" AND THEY TURNED IT OFF UNTIL IT WAS REPLACED. SHE SAID SHE THINKS THEY REPLACED THIS DEVICE WITH A NEW ONE. REGISTRATION INFORMATION ONLY SHOWS THE DEVICE IMPLANTATION ON (B)(4) 2010 AND NO FURTHER INFORMATION. THE DEVICE IS STILL IN USE. NO FURTHER PATIENT COMPLICATIONS HAVE BEEN REPORTED AS A RESULT OF THIS EVENT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 CONSULTA IMPLANTABLE PACEMAKER/CARDIO/DEFIB NIK MEDTRONIC MED REL, INC. D224TRK ASKU

    Patients

    Seq Age Sex Outcome Treatment
    1 78 YR Other (B)(4) IMPLANTABLE PACING LEAD| (B)(4) IMPLANTABLE TACHY LEAD| (B)(4) IMPLANTABLE PACING LEAD