BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    RELIA DR

    MDR report key: 2131605 · Received June 16, 2011

    Report

    Report Number
    6000094-2011-01173
    Event Type
    Malfunction
    Date Received
    June 16, 2011
    Date of Event
    April 15, 2011
    Manufacturer
    MEDTRONIC S.A.
    Product Code
    NVZ
    PMA / PMN Number
    P980035/S097
    Removal / Correction Number
    ASKU
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    PL
    Reporter Occupation
    PHYSICIAN

    Narratives

    Additional Manufacturer Narrative · 1

    THIS EVENT OCCURRED OUTSIDE THE US. ALL INFORMATION PROVIDED IS INCLUDED IN THIS REPORT. IF ADDITIONAL RELEVANT INFORMATION IS RECEIVED, A SUPPLEMENTAL REPORT WILL BE SUBMITTED. PATIENT INFORMATION IS NOT GENERALLY AVAILABLE DUE TO CONFIDENTIALITY CONCERNS. ANALYSIS OF THE DEVICE IS IN PROCESS; THE RESULTS WILL BE FORWARDED WHEN AVAILABLE.

    Additional Manufacturer Narrative · 1

    THIS EVENT OCCURRED OUTSIDE THE US. ALL INFORMATION PROVIDED IS INCLUDED IN THIS REPORT. IF ADDITIONAL RELEVANT INFORMATION IS RECEIVED, A SUPPLEMENTAL REPORT WILL BE SUBMITTED. PATIENT INFORMATION IS NOT GENERALLY AVAILABLE DUE TO CONFIDENTIALITY CONCERNS. EVALUATION SUMMARY: (B)(4), THE DEVICE WAS RETURNED AND ANALYZED. NO ANOMALIES WERE FOUND. IT WAS NOTED THE PACKAGING WAS DAMAGED.

    Description of Event or Problem · 1

    IT WAS REPORTED THAT THE DEVICE ARRIVED AT THE HOSPITAL WITH BROKEN PLASTIC CASE AND STERILE PACKAGE INTEGRITY WAS SUSPECTED TO BE DAMAGED. NO PATIENT COMPLICATIONS HAVE BEEN REPORTED AS A RESULT OF THIS EVENT.

    Description of Event or Problem · 1

    IT WAS REPORTED THAT THE DEVICE ARRIVED AT THE HOSPITAL WITH BROKEN PLASTIC CASE AND STERILE PACKAGE INTEGRITY WAS SUSPECTED TO BE DAMAGED. THE DEVICE WAS NEVER CONSIDERED FOR IMPLANTATION. NO PATIENT COMPLICATIONS HAVE BEEN REPORTED AS A RESULT OF THIS EVENT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 RELIA DR IMPLANTABLE PULSE GENERATOR NVZ MEDTRONIC S.A. REDR01 ASKU

    Patients

    Seq Age Sex Outcome Treatment
    1 Other