BEUDAMED
    FDA Adverse Event Other Summary report: N

    DEXTRUS 4136

    MDR report key: 2001834 · Received February 17, 2011

    Report

    Report Number
    1028232-2011-00382
    Event Type
    Other
    Date Received
    February 17, 2011
    Date of Event
    January 1, 2011
    Report Date
    February 14, 2011
    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 RECEIVED INFO THAT THIS RIGHT VENTRICULAR (RV) LEAD DISLODGED AND EXHIBITED LOSS OF CAPTURE (LOC) IN THIS NON-PACEMAKER DEPENDANT PT. A LEAD REVISION WILL LIKELY BE SCHEDULED FOR THE FUTURE. NO ADVERSE PT EFFECTS WERE REPORTED. NO ADD'L INFO IS AVAILABLE AT THIS TIME. IF ADD'L INFO BECOMES AVAILABLE, THIS REPORT WILL BE UPDATED.

    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 Other