SETROX S 45 350973 SEE MODEL NO.

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 05,07 report with the FDA on 2013-02-19 for SETROX S 45 350973 SEE MODEL NO. manufactured by Biotronik Se & Co. Kg.

Event Text Entries

[3129620] This system was removed due to (b)(6) endocarditis on (b)(6) 2012. There is no indication the system was replaced. Should additional info become available, this file will be updated.
Patient Sequence No: 1, Text Type: D, B5


[10636757] The device was not returned for analysis. Therefore the quality documents associated with the manufacture of this particular device were re-investigated. There was no sign of any inconsistency during production and final acceptance test. The biotronik sterilization protocol confirmed that all sterilization parameters, such as gas concentration, temperature, humidity, etc. , were in their specified ranges. Also, the investigation of the microbiological indicators showed the successful completion of the sterilization process. In summary, the infection was not device related.
Patient Sequence No: 1, Text Type: N, H10


MAUDE Entry Details

Report Number1028232-2013-00448
MDR Report Key2980991
Report Source05,07
Date Received2013-02-19
Date of Report2013-02-05
Date of Event2012-09-24
Date Mfgr Received2013-03-21
Device Manufacturer Date2011-07-08
Date Added to Maude2013-02-28
Event Key0
Report Source CodeManufacturer report
Manufacturer LinkY
Number of Patients in Event0
Adverse Event Flag3
Product Problem Flag3
Reprocessed and Reused Flag3
Health Professional3
Initial Report to FDA3
Report to FDA0
Event Location0
Manufacturer Street6024 JEAN ROAD
Manufacturer CityLAKE OSWEGO OR 97035
Manufacturer CountryUS
Manufacturer Postal97035
Manufacturer Phone8772459800
Manufacturer G1BIOTRONIK SE & CO KG
Manufacturer CityBERLIN
Manufacturer CountryGM
Single Use3
Previous Use Code3
Event Type3
Type of Report3

Device Details

Brand NameSETROX S 45
Generic NamePACER LEAD
Product CodeJXK
Date Received2013-02-19
Model Number350973
Catalog NumberSEE MODEL NO.
OperatorHEALTH PROFESSIONAL
Device AvailabilityN
Device AgeDA
Device Eval'ed by MfgrR
Device Sequence No1
Device Event Key0
ManufacturerBIOTRONIK SE & CO. KG
Manufacturer AddressWOERMANNKEHRE 1 BERLIN D-12359 GM D-12359


Patients

Patient NumberTreatmentOutcomeDate
101. Hospitalization 2013-02-19

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