MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a company representative report with the FDA on 2020-01-28 for ILIVIA 7 DR-T DF4 PROMRI 404623 SEE MODEL NO. manufactured by Biotronik Se & Co. Kg.
[176750454]
Pt had fluid leaking out of device pocket. No new equipment/leads used. Per physician, there was no known infection. He said oozing substance kept leaking out of the patients device pocket, therefore, he wanted to revise her pocket to curb against any potential infection. Device remains implanted. No adverse patient events were reported. Should additional information become available, this file will be updated.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 1028232-2020-00446 |
| MDR Report Key | 9639206 |
| Report Source | COMPANY REPRESENTATIVE |
| Date Received | 2020-01-28 |
| Date of Report | 2020-01-24 |
| Date of Event | 2020-01-24 |
| Date Mfgr Received | 2020-03-18 |
| Device Manufacturer Date | 2018-07-30 |
| Date Added to Maude | 2020-01-28 |
| Event Key | 0 |
| Report Source Code | Manufacturer report |
| Manufacturer Link | Y |
| Number of Patients in Event | 0 |
| Adverse Event Flag | 3 |
| Product Problem Flag | 3 |
| Reprocessed and Reused Flag | 3 |
| Reporter Occupation | OTHER HEALTH CARE PROFESSIONAL |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 3 |
| Event Location | 3 |
| Manufacturer Street | 6024 JEAN ROAD |
| Manufacturer City | LAKE OSWEGO OR 97035 |
| Manufacturer Country | US |
| Manufacturer Postal | 97035 |
| Manufacturer Phone | 8772459800 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | ILIVIA 7 DR-T DF4 PROMRI |
| Generic Name | ICD |
| Product Code | MRM |
| Date Received | 2020-01-28 |
| Model Number | 404623 |
| Catalog Number | SEE MODEL NO. |
| Device Expiration Date | 2020-01-31 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | N |
| Device Age | DA |
| Device Eval'ed by Mfgr | R |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | BIOTRONIK SE & CO. KG |
| Manufacturer Address | WOERMANNKEHRE 1 BERLIN 12359 12359 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Hospitalization | 2020-01-28 |