FDA Adverse Event Malfunction Summary report: N

LAUNCHER 6F (LCB)

MDR report key: 2043094 · Received March 15, 2011

Report

Report Number
1220452-2011-00017
Event Type
Malfunction
Date Received
March 15, 2011
Date of Event
February 11, 2011
Report Date
February 25, 2011
Manufacturer
MEDTRONIC, INC.
Product Code
DQY
PMA / PMN Number
K021256
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
TX, US
Reporter Occupation
PHYSICIAN

Narratives

Additional Manufacturer Narrative · 1

EVAL IS ANTICIPATED UPON RECEIPT OF THE DISCREPANT DEVICE. AN ENGINEERING ANALYSIS OF THE SUBJECT DEVICE WILL BE PERFORMED UPON RECEIPT. METHOD, CONCLUSION: OTHER.

Description of Event or Problem · 1

IT HAS BEEN REPORTED TO US THAT DURING THE PREPARATION OF THE GUIDE CATHETER, A HAIR LINE FRACTURE WAS NOTICED AT THE HUB. NO INJURY TO PT.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1 LAUNCHER 6F (LCB) DQY MEDTRONIC, INC. NA 0004522370

Patients

Seq Age Sex Outcome Treatment
1 NA