MAUDE Adverse Event Report: BIOTRONIK SE & CO. KG ENTOVIS SR-T PROMRI; PACEMAKER

Model Number 371994

Device Problem No Pacing (3268)

Patient Problem Bradycardia (1751)

Event Date 12/13/2022

Event Type  malfunction  

Event Description

On (b)(6) 2022 patient collapsed while working out, ems claimed patient was bradycardic and patient was taken to er where the physician determined that he was not receiving pacing.The pacing lead is a competitors lead.It is unclear whether this is a lead or device issue.Pacemaker was explanted.Should additional information become available, this file will be updated.

Manufacturer Narrative

The pacemaker was received for analysis.Prior to the analysis of the device, the quality documents accompanying the manufacturing process for this pacemaker were re-investigated and all production steps were performed accordingly.Particularly the final acceptance test proved the device functions to be as specified.Upon receipt, the pacemaker was visually inspected revealing no anomalies.In particular the header of the device was analyzed.The set screw could be easily screwed in and out, there was no foreign material inside the header bore.All dimensions of the header bore were within the range requested by the is-1 standard specifications.Also the spring element of the pacemaker did not show any deviations.At a next step the pacemaker was interrogated and the pacemakers memory content was analyzed indicating no anomalies.The battery was found to be in eri status since (b)(6) 2022 after the explantation of the device.The ability of the device to deliver therapies was verified.The anti-bradycardia pacing pulses proved to be normal and in amplitude and frequency as programmed.There was no indication of a device malfunction.An additional long-term pacing test was initiated.During the test, each pacing pulse was recorded.The evaluation of these pacing pulses documented regular device behavior.No intermittent or permanent loss of output was present.In summary, the device is fully functional.With regard to the issues as mentioned in the complaint description, the analysis did not show any deviations from the technical specifications.The analysis did not reveal any sign of a material or manufacturing problem.

• Brand Name: ENTOVIS SR-T PROMRI
• Type of Device: PACEMAKER
• Manufacturer (Section D): BIOTRONIK SE & CO. KG; woermannkehre 1; berlin 12359
• Manufacturer Contact: 6024 jean road; lake oswego, OR 97035 ; 8772459800
• MDR Report Key: 16205017
• MDR Text Key: 307698153
• Report Number: 1028232-2023-00244
• Device Sequence Number: 1
• Product Code: NVZ
• UDI-Device Identifier: 04035479115197
• UDI-Public: (01)04035479115197(17)151231
• Combination Product (y/n): N
• Reporter Country Code: US
• PMA/PMN Number: P950037
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Company Representative
• Reporter Occupation: Other Health Care Professional
• Type of Report: Initial,Followup
• Report Date: 12/13/2022

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Device Operator: Health Professional
• Device Expiration Date: 12/31/2015
• Device Model Number: 371994
• Device Catalogue Number: SEE MODEL NO.
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 01/24/2023
• Is the Reporter a Health Professional?: Yes
• Initial Date Manufacturer Received: 01/04/2023
• Initial Date FDA Received: 01/19/2023
• Supplement Dates Manufacturer Received: 03/10/2023
• Supplement Dates FDA Received: 03/10/2023
• Was Device Evaluated by Manufacturer?: Yes
• Date Device Manufactured: 06/03/2014
• Is the Device Single Use?: Yes
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: Initial
• Patient Sequence Number: 1
• Patient Outcome(s): Hospitalization
• Patient Age: 82 YR
• Patient Sex: Male