BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    REVO MRI SURESCAN

    MDR report key: 2790147 · Received October 15, 2012

    Report

    Report Number
    6000144-2012-05403
    Event Type
    Malfunction
    Date Received
    October 15, 2012
    Date of Event
    January 18, 2012
    Manufacturer
    MEDTRONIC MED REL, INC.
    Product Code
    LWP
    PMA / PMN Number
    P090013
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    SC, US
    Reporter Occupation
    OTHER

    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.

    Description of Event or Problem · 1

    IT WAS REPORTED THE PATIENT WENT THROUGH A METAL DETECTOR AND THE DEVICE "STARTED TO STING, LIKE A BEE STING". PATIENT ALSO FELT THE "STINGING" WHEN ENTERING A STORE AND THE ALARM WAS SET OFF BY A CUSTOMER LEAVING THE STORE. FOLLOW UP WITH THE PHYSICIAN'S OFFICE WAS CONDUCTED, BUT THE PATIENT HAD NOT BEEN SEEN. THE DEVICE REMAINS IN USE. NO FURTHER PATIENT COMPLICATIONS HAVE BEEN REPORTED AS A RESULT OF THIS EVENT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 REVO MRI SURESCAN IMPLANTABLE PULSE GENERATOR LWP MEDTRONIC MED REL, INC. RVDR01

    Patients

    Seq Age Sex Outcome Treatment
    1 56 YR Other (B)(4) X2 IMPLANTABLE PACING LEADS