BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    SECURA DR

    MDR report key: 2203486 · Received August 11, 2011

    Report

    Report Number
    6000144-2011-04187
    Event Type
    Malfunction
    Date Received
    August 11, 2011
    Manufacturer
    MEDTRONIC MED REL, INC.
    Product Code
    LWS
    PMA / PMN Number
    P980016/S114
    Removal / Correction Number
    ASKU
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    AR, US
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 1

    ASKU

    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 PATIENT WAS SYMPTOMATIC WHEN THEY STARTED THEIR (B)(4) WITH A (B)(4) MOTOR. THE PATIENT'S BLOOD PRESSURE WAS LOW. ELECTROMAGNETIC INTERFERENCE WAS A POSSIBLE CAUSE. THE DEVICE REMAINS IN USE. NO PATIENT COMPLICATIONS WERE REPORTED AS A RESULT OF THIS EVENT.

    Description of Event or Problem · 1

    IT WAS REPORTED THE PATIENT WAS SYMPTOMATIC WHEN THEY STARTED THEIR BUSHHOG WITH A DIESEL MOTOR. THE PATIENT'S BLOOD PRESSURE WAS LOW. ELECTROMAGNETIC INTERFERENCE WAS A POSSIBLE CAUSE. FOLLOW UP INFORMATION REVEALED THAT THE PATIENT WAS SEEN TWO MONTHS AFTER THE CALL AND THE DEVICE WAS FUNCTIONING APPROPRIATELY. THE DEVICE REMAINS IN USE. NO PATIENT COMPLICATIONS WERE REPORTED AS A RESULT OF THIS EVENT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 SECURA DR IMPLANTABLE PACEMAKER/CARDIO/DEFIB LWS MEDTRONIC MED REL, INC. D224DRG ASKU

    Patients

    Seq Age Sex Outcome Treatment
    1 81 YR Other 5076 IMPLANTABLE PACING LEAD| 6947 IMPLANTABLE TACHY LEAD| 5076 IMPLANTABLE PACING LEAD| 6947 IMPLANTABLE TACHY LEAD