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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: MEDTRONIC MILACA, INC. PACEART; ELECTROCARDIOGRAPH
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MEDTRONIC MILACA, INC. PACEART; ELECTROCARDIOGRAPH Back to Search Results
Model Number P127
Device Problem Electrical /Electronic Property Problem (1198)
Patient Problem No Known Impact Or Consequence To Patient (2692)
Event Date 11/05/2009
Event Type  malfunction  
Event Description
It was reported there was intermittent ecg (electrocardiogram) signal.The device was returned.No patient complications have been reported as a result of this event.
 
Manufacturer Narrative
This event was assessed and is being reported as a part of a retrospective review of events, which was in response to mdr criteria revisions and on-going process improvements.Product event summary: analysis could not confirm the reported event; device passed functional testing.(b)(4).
 
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Brand Name
PACEART
Type of Device
ELECTROCARDIOGRAPH
Manufacturer (Section D)
MEDTRONIC MILACA, INC.
900 sixth avenue ne
milaca MN 56353 372
Manufacturer (Section G)
MEDTRONIC CARDIAC RHYTHM HEART FAILURE
8200 coral sea st ne
mounds view MN 55112
Manufacturer Contact
anne schilling
8200 coral sea st ne
mounds view, MN 55112
7635052036
MDR Report Key4609782
MDR Text Key5694999
Report Number2183613-2015-00274
Device Sequence Number1
Product Code DPS
Combination Product (y/n)N
Reporter Country CodeCA
PMA/PMN Number
K024278
Number of Events Reported1
Summary Report (Y/N)N
Report Source Manufacturer
Source Type Foreign,Health Professional
Reporter Occupation Other
Type of Report Initial
Report Date 11/06/2009
1 Device was Involved in the Event
1 Patient was Involved in the Event
Date FDA Received03/17/2015
Is this an Adverse Event Report? No
Is this a Product Problem Report? Yes
Device Operator Health Professional
Device Model NumberP127
Device Catalogue NumberP127
Was Device Available for Evaluation? Device Returned to Manufacturer
Date Returned to Manufacturer01/05/2010
Date Manufacturer Received11/06/2009
Was Device Evaluated by Manufacturer? Yes
Is the Device Single Use? No
Is This a Reprocessed and Reused Single-Use Device? No
Patient Sequence Number1
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