BEUDAMED
    FDA Adverse Event Injury Summary report: N

    ESTELLA DR

    MDR report key: 2981011 · Received February 19, 2013

    Report

    Report Number
    1028232-2013-00446
    Event Type
    Injury
    Date Received
    February 19, 2013
    Date of Event
    September 24, 2012
    Report Date
    February 5, 2013
    Manufacturer
    BIOTRONIK SE & CO. KG
    Product Code
    JXK
    PMA / PMN Number
    P950038
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    OR, US
    Reporter Occupation
    NURSE

    Narratives

    Additional Manufacturer Narrative · 1

    THE DEVICE WAS EXPLANTED DUE TO ENDOCARDITIS. THE QUALITY DOCUMENTS ASSOCIATED WITH THE MANUFACTURE OF THIS PARTICULAR DEVICE WERE RE-INVESTIGATED. THERE WAS NO SIGN OF ANY INCONSISTENCY DURING PRODUCTION AND FINAL ACCEPTANCE TEST. THE BIOTRONIK STERILIZATION PROTOCOL CONFIRMED THAT ALL STERILIZATION PARAMETERS, SUCH AS GAS CONCENTRATION, TEMPERATURE, HUMIDITY, ETC., WERE IN THEIR SPECIFIED RANGES. ALSO, THE INVESTIGATION OF THE MICROBIOLOGICAL INDICATORS SHOWED THE SUCCESSFUL COMPLETION OF THE STERILIZATION PROCESS. IN SUMMARY, THE ENDOCARDITIS WAS NOT DEVICE RELATED.

    Description of Event or Problem · 1

    THIS SYSTEM WAS REMOVED DUE TO (B)(6) ENDOCARDITIS ON (B)(6) 2012. THERE IS NO INDICATION THE SYSTEM WAS REPLACED. SHOULD ADDITIONAL INFO BECOME AVAILABLE, THIS FILE WILL BE UPDATED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    72266 ESTELLA DR PACEMAKER JXK BIOTRONIK SE & CO. KG 371205

    Patients

    Seq Age Sex Outcome Treatment
    1 84 YR Hospitalization