MAUDE Adverse Event Report: PLEXUS MANUFACTURING SDN. BHD MYCARELINK; PULSE GENERATOR, PERMANENT, IMPLANTABLE

Model Number	24950D
Medical Device Problem Code	Overheating of Device (1437)
Health Effect - Clinical Code	No Known Impact Or Consequence To Patient (2692)
Date of Event	10/24/2016
Type of Reportable Event	Malfunction
Event or Problem Description
It was reported that the remote monitor started smoking.A new monitor was ordered for the patient.No patient complications have been reported as a result of this event.
Additional Manufacturer Narrative
If information is provided in the future, a supplemental report will be issued.
Additional Manufacturer Narrative
Remote monitor analysis: the monitor was returned and revealed that there was a software service error code indication and miscellaneous service error code indication.If information is provided in the future, a supplemental report will be issued.

• Brand Name: MYCARELINK
• Common Device Name: PULSE GENERATOR, PERMANENT, IMPLANTABLE
• Manufacturer (Section D): PLEXUS MANUFACTURING SDN. BHD; bayan lepas free industrial zo; bayan lepas 11900 ; MY 11900
• MDR Report Key: 6162366
• Report Number: 3004593495-2016-00526
• Device Sequence Number: 931783
• Product Code: NVZ
• UDI-Device Identifier: 00643169367203
• UDI-Public: 00643169367203
• Combination Product (Y/N): N
• Initial Reporter State: KY
• Initial Reporter Country: US
• PMA/510(K) Number: P890003
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: company representative,consum
• Initial Reporter Occupation: Other
• Type of Report: Initial,Followup,Followup
• Report Date (Section B): 07/21/2017

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: Lay User/Patient
• Device Model Number: 24950D
• Device Catalogue Number: 24950D
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 02/10/2017
• Initial Date Received by Manufacturer: 10/24/2016
• Supplement Date Received by Manufacturer: 10/24/2016; 07/21/2017
• Initial Report FDA Received Date: 12/09/2016
• Supplement Report FDA Received Date: 09/27/2017; 10/06/2017
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1
• Concomitant Medical Products and Therapy/Usage Dates: LNQ11, ICM
• Patient Age: 67 YR