MAUDE Adverse Event Report: GUIDANT CRM CLONMEL IRELAND CONTAK RENEWAL TR; IMPLANTABLE CHF GENERATOR

Model Number H140

Device Problem Insufficient Information (3190)

Patient Problem No Consequences Or Impact To Patient (2199)

Event Date 11/12/2013

Event Type  malfunction  

Event Description

Boston scientific received information that this product was returned with no reported product performance issues and no reported adverse patient effects.Initial analysis completed in our post market quality assurance laboratory indicated that the device could not be telemetered.

Manufacturer Narrative

Upon receipt at our post market quality assurance laboratory, the device could not be interrogated.Visual inspection noted large dents on the external device case.Testing of this product was not completed as the device was damaged and could not be fully functionally tested.

• Brand Name: CONTAK RENEWAL TR
• Type of Device: IMPLANTABLE CHF GENERATOR
• Manufacturer (Section D): GUIDANT CRM CLONMEL IRELAND; guidant ireland; clonmel, tipperary ireland
• Manufacturer (Section G): GUIDANT CRM CLONMEL IRELAND; guidant ireland; clonmel, tipperary ireland
• Manufacturer Contact: sharon zurn ; 4100 hamline ave. n; st. paul, MN 55112 ; 6515824786
• MDR Report Key: 3607087
• MDR Text Key: 4070113
• Report Number: 2124215-2013-21621
• Device Sequence Number: 1
• Product Code: NKE
• Combination Product (y/n): N
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Company Representative
• Type of Report: Initial
• Report Date: 11/12/2013

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: Other
• Device Expiration Date: 09/15/2011
• Device Model Number: H140
• Other Device ID Number: CONTAK RENEWAL TR2
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 08/05/2013
• Was the Report Sent to FDA?: Yes
• Initial Date Manufacturer Received: 11/12/2013
• Initial Date FDA Received: 02/04/2014
• Was Device Evaluated by Manufacturer?: No
• Date Device Manufactured: 09/18/2009
• 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
• Treatment: H140