BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    CARELINK

    MDR report key: 3153417 · Received June 8, 2013

    Report

    Report Number
    2182208-2013-01430
    Event Type
    Malfunction
    Date Received
    June 8, 2013
    Report Date
    March 20, 2013
    Manufacturer
    RICE CREEK MFG
    Product Code
    DXY
    PMA / PMN Number
    P890003
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    MN, US
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 1

    PRODUCT EVENT SUMMARY: THE RF (RADIO FREQUENCY) HEAD PASSED FUNCTIONAL TESTING. A DEVICE WAS INTERROGATED AND TELEMETRY REMAINED CONSTANT EVEN AS THE CABLE WAS MOVED BACK AND FORTH. THE RF HEAD CABLE WAS FOUND WITH SLIT IN IT EXPOSING THE BRAIDED WIRE. IT IS NOTED THE RUBBER PORTION OF THE RF HEAD LABEL IS MISSING.

    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).

    Additional Manufacturer Narrative · 1

    IF INFORMATION IS PROVIDED IN THE FUTURE, A SUPPLEMENTAL REPORT WILL BE ISSUED.

    Description of Event or Problem · 1

    IT WAS REPORTED THE RF (RADIO FREQUENCY) HEAD MALFUNCTIONED FROM STERILE PROCESSING AND PACER CLINIC. NO ADDITIONAL INFORMATION WAS OBTAINED THROUGH FOLLOW UP. THE RF HEAD WAS RETURNED FOR REPAIR. NO PATIENT COMPLICATIONS WERE REPORTED AS A RESULT OF THIS EVENT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    256923 CARELINK PULSE-GENERATOR, PACEMAKER, IMPLANTABLE DXY RICE CREEK MFG 2067

    Patients

    Seq Age Sex Outcome Treatment
    1