MAUDE MDR 1976627

MDR report key
1976627
Report number
1028232-2011-00197
Event key
0
Event type
3
Date of event
2010-12-24
Date received
2011-01-27
Adverse event
3
Product problem
3
Patients in event
0
Reporter occupation
2
Health professional
3
Initial report to FDA
3
Event location
0

Manufacturer Contact#

Address
6024 JEAN ROAD LAKE OSWEGO OR 97035 US
Phone
877-877-8772
Report source
M
Manufacturer link flag
Y

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1LUMAX 340 VR-TICDBIOTRONIK SE & CO. KGLWS355271355271* Y

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12011-01-2701. H

Event Narratives#

D

Patient 1

THIS DEVICE WAS EXPLANTED BECAUSE, IT IS AT EOS INDICATION DUE TO INTERMITTENT OVERSENSING, NOISE AND SEVERAL SHOCKS ON THE RV LEAD. THE PHYSICIAN SPECULATES THAT THERE MIGHT HAVE BEEN A LEAD FRACTURE.