BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    SELOX ST 53

    MDR report key: 2030313 · Received March 21, 2011

    Report

    Report Number
    1028232-2011-00618
    Event Type
    Malfunction
    Date Received
    March 21, 2011
    Date of Event
    March 8, 2011
    Report Date
    March 10, 2011
    Manufacturer
    BIOTRONIK SE & CO. KG
    Product Code
    NVZ
    PMA / PMN Number
    P950037
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    OR, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    THIS LEAD WAS EXPLANTED DUE TO OVERSENSING AND TOTAL LOSS OF CAPTURE. NO ADD'L INFO IS AVAILABLE AT THIS TIME. SHOULD ADD'L INFO BECOME AVAILABLE, THIS EVENT WILL BE UPDATED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 SELOX ST 53 PACER LEAD NVZ BIOTRONIK SE & CO. KG 346366

    Patients

    Seq Age Sex Outcome Treatment
    1 81 YR Hospitalization