FDA Adverse Event Other Summary report: N

POLYROX 45 JBP

MDR report key: 736826 · Received July 17, 2006

Report

Report Number
1028232-2006-00132
Event Type
Other
Date Received
July 17, 2006
Date of Event
January 1, 2006
Report Date
July 11, 2006
Manufacturer
BIOTRONIK GMBH AND CO.
Product Code
DTB
PMA / PMN Number
P750037
Adverse Event
Yes
Report Source
Manufacturer report
Reporter Location
CO, US
Reporter Occupation
NOT APPLICABLE

Narratives

Description of Event or Problem · 1

EXPLANTED DUE TO INFECTION. LEADS WERE LASER EXTRACTED. PT HAD PREVIOUS POCKET REVISIONS. ALSO INVOLVED ARE A PHILOS DR ACC, MDR 06-0131 AND POLYROX 53/15, MDR 09-0133. IN 2006, REP REPORTED THAT THE INFECTION CLEARED AND THE PT WAS IMPLANTED WITH A NEW SYSTEM TODAY

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1 POLYROX 45 JBP BRADYCARDIA LEAD DTB BIOTRONIK GMBH AND CO. 120 435 *

Patients

Seq Age Sex Outcome Treatment
1 62 YR Hospitalization