FDA.reportPublic FDA data

MAUDE MDR 2057942

MDR report key
2057942
Report number
1028232-2011-00817
Event key
0
Event type
3
Date of event
2011-02-16
Date received
2011-04-07
Adverse event
3
Product problem
3
Patients in event
0
Reporter occupation
0
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
1DEXTRUS 4136PACER LEADBIOTONIK SE & CO. KGNVZ358754358754R N

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12011-04-0701. H

Event Narratives#

N

Patient 1

THE DEVICE WAS NOT RETURNED FOR ANALYSIS. THE ANALYSIS IS THEREFORE BASED ON THE INSPECTION OF THE QUALITY DOCUMENTS ACCOMPANYING THIS PARTICULAR DEVICE. THE MFG PROCESS FOR THIS DEVICE WAS RE-INVESTIGATED. ALL PRODUCTION STEPS HAD BEEN PERFORMED ACCORDINGLY. THERE WAS NO SIGN OF ANY INCONSISTENCY DURING THE MFG PROCESS, WHICH MIGHT BE RELATED TO THE CLINICAL OBSERVATION. IN SUMMARY, THE DEVICE WAS NOT RETURNED FOR ANALYSIS. THE REVIEW OF THE QUALITY DOCUMENTS CONFIRMED A REGULAR DEVICE MFG.

D

Patient 1

BOSTON SCIENTIFIC RECEIVED INFO THAT THIS IMPLANTABLE RIGHT ATRIAL (RA) LEAD DISLODGED 10 DAYS POST IMPLANT. THE LEAD DISLODGMENT WAS VERIFIED BY A CHEST X-RAY. IT WAS REPORTED THE LEAD WAS ABLE TO PROVIDE INTRINSIC SENSING MEASUREMENTS BUT NO PACING THERAPY. A REVISION PROCEDURE TOOK PLACE AND THE LEAD WAS SUCCESSFULLY REPOSITIONED. AS NO FURTHER INFO CONCERNING THIS REPORT IS EXPECTED, OUR INVESTIGATION IS COMPLETE. THIS INVESTIGATION WILL BE UPDATED SHOULD FURTHER INFO BE PROVIDED.