BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    ASKU

    MDR report key: 2131498 · Received June 16, 2011

    Report

    Report Number
    2183613-2011-00290
    Event Type
    Malfunction
    Date Received
    June 16, 2011
    Date of Event
    March 28, 2011
    Manufacturer
    MEDTRONIC MILACA INC.
    Product Code
    DTE
    PMA / PMN Number
    P820003/S72
    Removal / Correction Number
    ASKU
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    MI, US
    Reporter Occupation
    BIOMEDICAL ENGINEER

    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. ANALYSIS OF THE DEVICE IS IN PROCESS; THE RESULTS WILL BE FORWARDED WHEN AVAILABLE.

    Additional Manufacturer Narrative · 1

    THE INFORMATION SUBMITTED REFLECTS ALL RELEVANT DATA RECEIVED. IF ADDITIONAL RELEVANT INFORMATION IS RECEIVED, A SUPPLEMENTAL REPORT WILL BE SUBMITTED. EVALUATION SUMMARY: (B)(4): ANALYSIS COULD NOT CONFIRM THE INITIAL CUSTOMER COMMENT. ANALYSIS DID FIND THAT THE UPPER AND LOWER CASES WERE BROKEN, THE RING COVER AND TWO SIDE BAIL COVERS WERE BROKEN, THE BATTERY RELEASE AND LEAD FLEX COVER WERE BROKEN, THE BATTERY CONTACTS WERE CONTAMINATED, THE RING WAS BENT AND ONE SIDE BAIL WAS MISSING, THE BATTERY DRAWER WAS BROKEN, AND THE KEYBOARD PAD WAS COSMETICALLY SCRATCHED AND PITTED.

    Description of Event or Problem · 1

    IT WAS REPORTED THE DEVICE WAS ASYNC PACING ONLY. IT WAS FURTHER REPORTED THE DEVICE WAS "STUCK" IN EMERGENCY MODE AND WOULD NOT COME OUT OF THAT POSITION. NO PATIENT INVOLVEMENT OR COMPLICATIONS WERE REPORTED AS A RESULT OF THIS EVENT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ASKU EXTERNAL PULSE GENERATOR DTE MEDTRONIC MILACA INC. 5388 ASKU

    Patients

    Seq Age Sex Outcome Treatment
    1 Other