FDA Adverse Event
Injury
Summary report: N
PULSE GEN MODEL 102
MDR report key: 3201140
·
Received July 2, 2013
Report
- Report Number
- 1644487-2013-02006
- Event Type
- Injury
- Date Received
- July 2, 2013
- Date of Event
- June 7, 2013
- Report Date
- June 7, 2013
- Manufacturer
- CYBERONICS INC
- Product Code
- LYJ
- PMA / PMN Number
- P970003
- Removal / Correction Number
- NA
- Adverse Event
- Yes
- Report Source
- Manufacturer report
- Reporter Location
- CA, US
- Reporter Occupation
- PHYSICIAN
Narratives
Description of Event or Problem · 1
ON (B)(4) 2013 IT WAS REPORTED THAT THE VNS PATIENT HAS A FIRST DEGREE AV BLOCK. NO FURTHER INFORMATION WAS PROVIDED. GOOD FAITH ATTEMPTS FOR FURTHER INFORMATION FROM THE PHYSICIAN WERE MADE BUT NO ADDITIONAL INFORMATION WAS RECEIVED.
Devices
| Seq | Brand | Generic | Product Code | Manufacturer | Model | Lot | UDI-DI |
|---|---|---|---|---|---|---|---|
| 303250 | PULSE GEN MODEL 102 | GENERATOR | LYJ | CYBERONICS INC | 102 | 200622 |
Patients
| Seq | Age | Sex | Outcome | Treatment |
|---|---|---|---|---|
| 1 | 66 YR | Other |