MAUDE Adverse Event Report: BIOTRONIK SE & CO. KG SIELLO JT 53; LEAD

Model Number	362704
Medical Device Problem Code	Failure to Capture (1081)
Health Effect - Clinical Code	No Known Impact Or Consequence To Patient (2692)
Date of Event	08/17/2020
Type of Reportable Event	Malfunction
Event or Problem Description
After an implantation period of approx.101 months, it was observed that there was a loss of capture on the atrial lead.The leads were capped.
Additional Manufacturer Narrative
As of today, the medical devices are not available for analysis, therefore the devices themselves could not be investigated.The analysis is thus based on the inspection of the manufacturing documents of the devices as well as on the provided data.The manufacturing process for these devices was re-investigated.All production steps had been performed accordingly.There was no sign of any inconsistency during the manufacturing process.The analysis of the provided iegm episodes revealed artifacts on the rv channel, which led to the reported oversensing as well as inappropriate shock delivery and icd charging cycle.In spite of the available information, no conclusion can be drawn regarding the root cause of the clinical observation.An analysis of the lead itself would be necessary to determine the root cause.Should additional information or the device itself become available for analysis, the investigation will be updated.

• Brand Name: SIELLO JT 53
• Common Device Name: LEAD
• Manufacturer (Section D): BIOTRONIK SE & CO. KG; woermannkehre 1; berlin 12359
• MDR Report Key: 10457629
• Report Number: 1028232-2020-03627
• Device Sequence Number: 4016195
• Product Code: NVN
• UDI-Device Identifier: 04035479106249
• UDI-Public: 04035479106249
• Combination Product (Y/N): N
• PMA/510(K) Number: P950037
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2012
• Reporter Type: Manufacturer
• Report Source: company representative,foreig
• Initial Reporter Occupation: Other Health Care Professional
• Type of Report: Initial,Followup
• Report Date (Section B): 08/20/2020

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
• Operator of Device: Health Professional
• Device Expiration Date: 02/28/2014
• Device Model Number: 362704
• Device Catalogue Number: SEE MODEL NO.
• Was Device Available for Evaluation?: No
• Initial Date Received by Manufacturer: 08/26/2020
• Supplement Date Received by Manufacturer: 04/09/2021
• Initial Report FDA Received Date: 08/26/2020
• Supplement Report FDA Received Date: 04/12/2021
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1
• Outcome Attributed to Adverse Event: Hospitalization