BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    KENTROX SL-S 65/16 STEROID

    MDR report key: 3120334 · Received May 20, 2013

    Report

    Report Number
    1028232-2013-01475
    Event Type
    Malfunction
    Date Received
    May 20, 2013
    Date of Event
    December 3, 2012
    Report Date
    May 1, 2013
    Manufacturer
    BIOTRONIK SE & CO. KG
    Product Code
    NVY
    PMA / PMN Number
    P980023
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    OR, US
    Reporter Occupation
    NURSE

    Narratives

    Additional Manufacturer Narrative · 1

    THE DEVICE WAS NOT RETURNED FOR ANALYSIS. THE ANALYSIS IS THEREFORE BASED ON THE INSPECTION OF THE QUALITY DOCUMENTS ASSOCIATED WITH THE MANUFACTURE OF THIS PARTICULAR DEVICE. THE MANUFACTURING PROCESS FOR THIS DEVICE WAS RE-INVESTIGATED. ALL PRODUCTION STEPS HAD BEEN PERFORMED ACCORDINGLY. THERE WAS NO SIGN OF ANY INCONSISTENCY DURING THE MANUFACTURING PROCESS WHICH MIGHT BE RELATED TO THE CLINICAL OBSERVATION. IN SUMMARY, THE DEVICE WAS NOT RETURNED FOR ANALYSIS. THE REVIEW OF THE QUALITY DOCUMENTS CONFIRMED A REGULAR DEVICE MANUFACTURING.

    Description of Event or Problem · 1

    THE PACE/SENSE PORTION OF THIS LEAD WAS CAPPED ON (B)(6) 2012 DUE TO LOW IMPEDANCES AND NOISE, WHICH THE PHYSICIAN THOUGHT WERE RELATED TO A POSSIBLE INSULATION BREAK. THE PHYSICIAN REPLACED THE PACE/SENSE PORTION OF THIS LEAD WITH A PACING LEAD. THE SHOCK COILS FOR THIS LEAD REMAIN ACTIVELY IMPLANTED. SHOULD ADDITIONAL INFORMATION BE RECEIVED, THIS FILE WILL BE UPDATED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    222387 KENTROX SL-S 65/16 STEROID ICD LEAD NVY BIOTRONIK SE & CO. KG 345988

    Patients

    Seq Age Sex Outcome Treatment
    1 83 YR Hospitalization