FDA Adverse Event Other Summary report: N

GOODMAN CO. LTD

MDR report key: 812437 · Received January 11, 2007

Report

Report Number
2243801-2006-00025
Event Type
Other
Date Received
January 11, 2007
Date of Event
December 7, 2006
Report Date
January 5, 2007
Manufacturer
B. BRAUN MEDICAL, INC.
Product Code
DYB
Removal / Correction Number
NA
Adverse Event
Yes
Report Source
Manufacturer report
Reporter Occupation
OTHER HEALTH CARE PROFESSIONAL

Narratives

Additional Manufacturer Narrative · 1

THE ACTUAL DEVICE IN THE INCIDENT WAS RETURNED TO THE MFR FOR EVAL. VISUAL INSPECTION OF THE RETURNED UNIT INDICATES THAT THE UNIT WAS NOT USED IN VIVO. THE UNIT DID NOT PASS PROXIMAL CONTINUITY TESTING. MICROSCOPIC INVESTIGATION OF THE PROXIMAL ELECTRODE DISCOVERED THAT THE PROXIMAL WIRE WAS NOT SOLDERED COMPLETELY. MINIMAL SOLDER IS EVIDENT AND THEREFORE, DURING MANIPULATION CONTRIBUTED TO DISCONNECTION.

Description of Event or Problem · 1

PACING FAILURE. NO RESPONSE FROM PRODUCT.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1 GOODMAN CO. LTD PACING CATHETER DYB B. BRAUN MEDICAL, INC. NA 60766684

Patients

Seq Age Sex Outcome Treatment
1 YR Other