| Brand Name | MYOPORE® SUTURELESS MYOCARDIAL PACING LEAD |
| Common Device Name | BIPOLAR EPICARDIAL LEAD |
| Manufacturer (Section D) |
| GREATBATCH MEDICAL |
| 2300 berkshire lane |
| plymouth MN 55441 |
|
| Manufacturer (Section G) |
| GREATBATCH MEDICAL |
| 2300 berkshire lane |
|
| plymouth MN 55441 |
|
| Manufacturer Contact |
|
jacob
lee
|
| 2300 berkshire lane |
| plymouth, MN 55441
|
|
| MDR Report Key | 25660886 |
| Report Number | 2183787-2026-00044 |
| Device Sequence Number | 5596930 |
| Product Code |
DTB
|
| UDI-Device Identifier | 00821329900228 |
| UDI-Public | (01)00821329900228(11)231101(17)261101(20)00 |
| Combination Product (Y/N) | N |
| Initial Reporter State | MN |
| Initial Reporter Country | US |
| PMA/510(K) Number | P130012 |
| Number of Events Summarized | 1 |
| Summary Report (Y/N) | N |
| Device Implanted Year | 2024 |
| Serviced by Third Party (Y/N) | N |
| Reporter Type |
Manufacturer
|
| Report Source |
Distributor |
| Initial Reporter Occupation |
Non-Healthcare Professional
|
| Type of Report
| Initial |
| Report Date (Section B) |
06/29/2026 |
| 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
|
| Operator of Device |
Health Professional
|
| Device Model Number | 511212 |
| Device Lot Number | W8771932 |
| Was Device Available for Evaluation? |
No
|
| Type of Report(Section G) | Thirty-Day |
| Initial Date Received by Manufacturer | 06/05/2026 |
| Initial Report FDA Received Date | 06/29/2026 |
| Was Device Evaluated by Manufacturer? (Y/N) |
No
|
| Date Device Manufactured | 11/01/2023 |
| Is the Device Labeled for Single Use? (Y/N) |
Yes
|
Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N) |
No
|
| Usage of Device |
Initial
|
| Patient Sequence Number | 1 |
| Outcome Attributed to Adverse Event |
Required Intervention;
|
| Patient Sex | Unknown |