BEUDAMED
    FDA Adverse Event Injury Summary report: N

    SELOX ST 53

    MDR report key: 777150 · Received November 3, 2006

    Report

    Report Number
    1028232-2006-00233
    Event Type
    Injury
    Date Received
    November 3, 2006
    Date of Event
    October 17, 2006
    Report Date
    October 26, 2006
    Manufacturer
    BIOTRONIK GMBH CO.
    Product Code
    DTB
    PMA / PMN Number
    P950037
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CA, US
    Reporter Occupation
    NOT APPLICABLE

    Narratives

    Description of Event or Problem · 1

    SYSTEM EXPLANTED DUE TO INFECTION. OTHER DEVICES RELATED TO THIS SYSTEM: PROTOS DR/CLS, MDR 1028232-06-0230 AND SELOX SR 45, MDR 10328232-06-0231. DEVICES NOT RETURNED TO BIOTRONIK.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 SELOX ST 53 PACER LEAD DTB BIOTRONIK GMBH CO. 346366 *

    Patients

    Seq Age Sex Outcome Treatment
    1 65 YR Hospitalization