| Brand Name | Plexa ProMRI S 65 |
| Common Device Name | ICD lead |
| Manufacturer (Section D) |
| Biotronik SE & Co. KG |
| woermannkehre 1 |
| berlin 12359 |
| GM 12359 |
|
| Manufacturer Contact |
|
|
| 6024 jean road |
| lake oswego, OR 97035
|
|
+1(877)245-9800
|
|
| MDR Report Key | 50954937 |
| Report Number | 1028232-2026-04534 |
| Device Sequence Number | 21220459 |
| Product Code |
NVY
|
| UDI-Device Identifier | 04035479140021 |
| UDI-Public | (01)04035479140021(17)180131 |
| Combination Product (Y/N) | Y |
| Initial Reporter State | MA |
| Initial Reporter Country | US |
| PMA/510(K) Number | P980023 |
| Number of Events Summarized | 1 |
| Summary Report (Y/N) | N |
| Device Implanted Year | 2017 |
| Serviced by Third Party (Y/N) | N |
| Reporter Type |
Manufacturer
|
| Report Source |
Health Professional |
| Initial Reporter Occupation |
Other Health Care Professional
|
| Type of Report
| Initial |
| Report Date (Section B) |
09/30/2026 |
| 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 | 01/31/2018 |
| Device Model Number | 402266 |
| Device Catalogue Number | 402266 |
| Was Device Available for Evaluation? |
No
|
| Is the Reporter a Health Professional? |
Yes
|
| Type of Report(Section G) | Thirty-Day |
| Initial Date Received by Manufacturer | 09/23/2026 |
| Initial Report FDA Received Date | 09/30/2026 |
| Date Device Manufactured | 04/27/2017 |
| 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 |
| Patient Sex | Male |
|
|