BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    KAPPA 400 SR

    MDR report key: 2052971 · Received April 13, 2011

    Report

    Report Number
    6000144-2011-01568
    Event Type
    Malfunction
    Date Received
    April 13, 2011
    Date of Event
    January 31, 2011
    Manufacturer
    MEDTRONIC MED REL, INC.
    Product Code
    DXY
    PMA / PMN Number
    P970012
    Removal / Correction Number
    ASKU
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    MN, US
    Reporter Occupation
    MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE

    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 THE DEVICE WAS INTERROGATED PRIOR TO IMPLANT AND ELECTIVE REPLACEMENT WAS INDICATED TO REPLACE BATTERY. UPON RE-INTERROGATION IT NO LONGER SAID ELECTIVE REPLACEMENT INDICATED. THE DEVICE WAS NOT IMPLANTED. NO PATIENT COMPLICATIONS HAVE BEEN REPORTED AS A RESULT OF THIS EVENT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 KAPPA 400 SR IMPLANTABLE PULSE GENERATOR DXY MEDTRONIC MED REL, INC. KSR403 ASKU

    Patients

    Seq Age Sex Outcome Treatment
    1 Other