BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    SELOX ST 53

    MDR report key: 3984476 · Received August 6, 2014

    Report

    Report Number
    1028232-2014-002759
    Event Type
    Malfunction
    Date Received
    August 6, 2014
    Date of Event
    July 21, 2014
    Report Date
    July 25, 2014
    Manufacturer
    BIOTRONIK SE & CO. KG
    Product Code
    NVN
    PMA / PMN Number
    P950037
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    OR, US
    Reporter Occupation
    NURSE

    Narratives

    Additional Manufacturer Narrative · 1

    THE DEVICE IS CURRENTLY NOT AVAILABLE FOR ANALYSIS. NO CONCLUSION CAN BE DRAWN AT THIS TIME. THE INVESTIGATION WILL BE RE-OPENED, SHOULD ADDITIONAL DATA BECOME AVAILABLE.

    Description of Event or Problem · 1

    THIS LEAD WAS CAPPED DUE TO INTERMITTENT LOSS OF CAPTURE. SHOULD ADDITIONAL INFORMATION BECOME AVAILABLE, THIS FILE WILL BE UPDATED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    459440 SELOX ST 53 PACER LEAD NVN BIOTRONIK SE & CO. KG 346366

    Patients

    Seq Age Sex Outcome Treatment
    1 81 YR Hospitalization