BEUDAMED
    FDA Adverse Event Injury Summary report: N

    ACCUFIX

    MDR report key: 213954 · Received March 10, 1999

    Report

    Report Number
    1723248-1999-00142
    Event Type
    Injury
    Date Received
    March 10, 1999
    Date of Event
    January 13, 1999
    Report Date
    March 10, 1999
    Manufacturer
    TELECTRONICS PACING SYSTEMS
    Product Code
    DTB
    Removal / Correction Number
    Z-209/211/5
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CA, US
    Reporter Occupation
    PHYSICIAN

    Narratives

    Description of Event or Problem · 1

    THE LEAD WAS EXPLANTED DUE TO A REPORT OF J RETENTION WIRE FRACTURE WITHOUT PROTRUSION THROUGH THE OUTER POLYURETHANE INSULATION. POST OPERATIVE VISUAL BY THE PHYSICIAN NOTED THAT THE LEAD WAS APPARENTLY NOT FRACTURED. EXPLANT METHOD: INTRAVASCULAR, FEMORAL. TECHNIQUE/TOOLS: NOT PROVIDED. NO COMPLICATIONS.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ACCUFIX Implant PERM IMPL PACER ELECTRODE DTB TELECTRONICS PACING SYSTEMS 330-801 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 77 YR Required Intervention