MAUDE Adverse Event Report: SORIN GROUP ITALIA S.R.L. - CRM FACILITY REPLY; PULSE GENERATOR, PERMANENT, IMPLANTABLE

Model Number ESPRIT SR

Device Problem Connection Problem (2900)

Patient Problem No Information (3190)

Event Date 03/24/2017

Event Type  Injury  

Event Description

On (b)(6) 2017, the subject pacemaker was tried to be implanted with the lead xfine.During the implantation procedure, it was not possible to connect the lead to the pacemaker.Finally, it was decided to replace the pacemaker by another pacemaker working properly.The xfine remains implanted.

Event Description

On (b)(6) 2017, the subject pacemaker was tried to be implanted with the lead xfine.During the implantation procedure, it was not possible to connect the lead to the pacemaker.Finally, it was decided to replace the pacemaker by another pacemaker working properly.The xfine remains implanted.

• Brand Name: REPLY
• Type of Device: PULSE GENERATOR, PERMANENT, IMPLANTABLE
• Manufacturer (Section D): SORIN GROUP ITALIA S.R.L. - CRM FACILITY; parc d'affaires noveos 4 avenue réaumur; .; clamart 92140 ; FR 92140
• Manufacturer (Section G): SORIN GROUP ITALIA SRL VIA CRESCENTINO 13040 SALUGGIA ITALY; parc d'affaires noveos 4 avenue réaumur; .; clamart 92140 ; FR 92140
• Manufacturer Contact: elodie vincent ; parc d'affaires noveos 4 avenue réaumur; .; clamart 92140 ; FR 92140 ; 0146013665
• MDR Report Key: 6486037
• MDR Text Key: 72559225
• Report Number: 1000165971-2017-00303
• Device Sequence Number: 1
• Product Code: DXY
• Combination Product (y/n): N
• Reporter Country Code: SP
• PMA/PMN Number: P950029
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: health professional
• Reporter Occupation: Physician
• Type of Report: Initial,Followup
• Report Date: 03/30/2017

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: No
• Device Operator: Physician
• Device Expiration Date: 05/03/2018
• Device Model Number: ESPRIT SR
• Device Catalogue Number: ESPRIT SR
• Device Lot Number: S0220
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 04/07/2017
• Is the Reporter a Health Professional?: Yes
• Distributor Facility Aware Date: 03/30/2017
• Event Location: Hospital
• Initial Date Manufacturer Received: 03/30/2017
• Initial Date FDA Received: 04/12/2017
• Supplement Dates Manufacturer Received: Not provided
• Supplement Dates FDA Received: 05/29/2017
• Was Device Evaluated by Manufacturer?: Yes
• Date Device Manufactured: 10/03/2016
• 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): Required Intervention