MAUDE Adverse Event Report: MEDTRONIC PERMANENT PACEMAKER ELECTRODE

Model Number 4968

Device Problem Insufficient Information (3190)

Patient Problem Unspecified Infection (1930)

Event Date 07/23/2018

Event Type  Injury  

Event Description

This ra lead was implanted on (b)(6) 2013 and was capped on (b)(6) 2018.A product experience report receive on 07/23/2018 stated that this lead was part of a system infection.The physician was dr.(b)(6).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: 17536544
• MDR Text Key: 321144420
• Report Number: MW5143431
• 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: 10/17/2018

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: 4968
• Patient Sequence Number: 1