BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    TRANSVENOUS LEAD

    MDR report key: 2952938 · Received February 9, 2013

    Report

    Report Number
    2649622-2013-00769
    Event Type
    Malfunction
    Date Received
    February 9, 2013
    Report Date
    November 19, 2012
    Manufacturer
    MPRI
    Product Code
    DTB
    PMA / PMN Number
    K772203
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    IA, US
    Reporter Occupation
    PHYSICIAN

    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. (B)(4).

    Description of Event or Problem · 1

    IT WAS REPORTED THAT THE RIGHT VENTRICULAR (RV) LEAD HAD A HIGH THRESHOLD AND THE IMPEDANCE TREND HAD STARTED DECREASING. THE RV LEAD IS STILL IN USE. NO PATIENT COMPLICATIONS HAVE BEEN REPORTED AS A RESULT OF THIS EVENT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    56915 TRANSVENOUS LEAD ELECTRODE, PACEMAKER, PERMANENT DTB MPRI 696258

    Patients

    Seq Age Sex Outcome Treatment
    1 00063 YR ADSR03 IMPLANTABLE PULSE GENERATOR