MAUDE MDR 2629848

MDR report key
2629848
Report number
1028232-2012-01630
Event key
0
Event type
3
Date of event
2012-05-25
Date received
2012-06-22
Adverse event
3
Product problem
3
Patients in event
0
Reporter occupation
2
Health professional
0
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
1EVIA DR-TPACEMAKERBIOTRONIK SE & CO. KGNVZ359529359529* R

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12012-06-2201. H

Event Narratives#

D

Patient 1

THIS DEVICE AND THE RV LEAD WERE EXPLANTED AND REPLACED DUE TO TOTAL LOSS OF SENSING.