MAUDE Adverse Event Report: MEDTRONIC PERMANENT PACEMAKER ELECTRODE

Model Number 5568

Device Problem Use of Device Problem (1670)

Patient Problem Insufficient Information (4580)

Event Date 09/20/2017

Event Type  malfunction  

Event Description

This ra lead was implanted on (b)(6) 2004 and was capped on (b)(6) 2017 due to unknown product performance issue.The physician was dr.(b)(6) at (b)(6) medical center in bend, or.No other information is available.This report reflects information received by fda in the form of a notification per 803.22 (b)(2).

• Brand Name: PERMANENT PACEMAKER ELECTRODE
• Type of Device: PERMANENT PACEMAKER ELECTRODE
• Manufacturer (Section D): MEDTRONIC
• MDR Report Key: 17532802
• MDR Text Key: 321198645
• Report Number: MW5139709
• Device Sequence Number: 1
• Product Code: DTB
• Combination Product (y/n): N
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Voluntary
• Reporter Occupation: Other
• Type of Report: Initial
• Report Date: 10/17/2017

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 08/12/2023
• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: No
• Device Model Number: 5568
• Patient Sequence Number: 1