MAUDE MDR 2568237

MDR report key
2568237
Report number
1028232-2012-01136
Event key
0
Event type
3
Date of event
2012-04-20
Date received
2012-05-04
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 HF-TCRT-DBIOTRONIK SE & CO. KGMRM355263355263* Y

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12012-05-0401. H

Event Narratives#

D

Patient 1

THE RV LEAD EXHIBITED OVERSENSING AND NOISE. THIS DEVICE IS AT EOS INDICATION. THIS DEVICE WAS REPLACED AND THE PACE/SENSE PORTION OF THE RV LEAD WAS CAPPED ON (B)(6) 2012.