BEUDAMED
    FDA Adverse Event Injury Summary report: N

    POSSIS SUTURELESS MYOCARDIAL LEAD

    MDR report key: 27700 · Received October 11, 1995

    Report

    Report Number
    2124215-1995-00089
    Event Type
    Injury
    Date Received
    October 11, 1995
    Date of Event
    September 27, 1995
    Report Date
    October 10, 1995
    Manufacturer
    POSSIS MEDICAL, INC.
    Product Code
    LWS
    Adverse Event
    Yes
    Report Source
    Distributor report
    Reporter Location
    IN, US
    Reporter Occupation
    UNKNOWN

    Narratives

    Description of Event or Problem · 1

    THIS LEAD, & ANOTHER MODEL 4320 LEAD, SERIAL NUMBER 011142, WERE REMOVED FROM SERVICE BECAUSE OF A PRODUCT PERFORMANCE ISSUE. THE FORM STATED THAT ONE OF THE LEADS WAS "BROKEN". IT WAS NOT KNOWN WHICH LEAD WAS "BROKEN". IMPLANTED-3/17/92. REMOVED FROM SERVICE-9/27/95. TOTAL IMPLANT TIME-42 MO.DEVICE LABELED FOR SINGLE USE. PATIENT MEDICAL STATUS PRIOR TO EVENT: INVALID DATA. THERE WAS NOT MULTIPLE PATIENT INVOLVEMENT.INVALID DATA - ON DEVICE SERVICE/MAINTENANCE. NO DATA - REGARDING DATE LAST SERVICED. SERVICE PROVIDED BY: INVALID DATA. INVALID DATA - SERVICE RECORDS AVAILABILITY.NO IMMINENT HAZARD TO PUBLIC HEALTH CLAIMED. DEVICE USED AS LABELED/INTENDED.INVALID DATA - REGARDING EVALUATION BY USER AFTER EVENT. METHOD OF EVALUATION: INVALID DATA. RESULTS OF EVALUATION: INVALID DATA. CONCLUSION: INVALID DATA. CERTAINTY OF DEVICE AS CAUSE OF OR CONTRIBUTOR TO EVENT: INVALID DATA. CORRECTIVE ACTIONS: NO DATA. INVALID DATA - ON DEVICE DESTROYED/DISPOSED OF STATUS.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 POSSIS SUTURELESS MYOCARDIAL LEAD Implant LEAD LWS POSSIS MEDICAL, INC. 4320 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 UNK Required Intervention