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

Model Number	2490C15
Medical Device Problem Codes	Inappropriate/Inadequate Shock/Stimulation (1574); Communication or Transmission Problem (2896)
Health Effect - Clinical Code	No Known Impact Or Consequence To Patient (2692)
Date of Event	10/09/2017
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
If information is provided in the future, a supplemental report will be issued.
Event or Problem Description
It was reported that the remote monitor was able to connect but did not send successfully.The patient also experienced shocks when transmitting.The remote monitor and e-cellular accessory were moved to different locations.The remote monitor was power cycled and phone connections were checked.The monitor status is still in use.No patient complications have been reported as a result of this event.
Additional Manufacturer Narrative
Product analysis: model: 2490c15, serial/lot#: (b)(4): the remote monitor was returned and analysis revealed that there was no defect found.If information is provided in the future, a supplemental report will be issued.
Event or Problem Description
The monitor was replaced and returned.

• Brand Name: CARELINK
• 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: 7092172
• Report Number: 3004593495-2017-00717
• Device Sequence Number: 1874564
• Product Code: NVZ
• UDI-Device Identifier: 00643169334717
• UDI-Public: 00643169334717
• Combination Product (Y/N): N
• Initial Reporter Country: US
• PMA/510(K) Number: P890003
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: consumer
• Initial Reporter Occupation: Other
• Type of Report: Initial,Followup
• Report Date (Section B): 06/10/2019

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: 2490C15
• Device Catalogue Number: 2490C15
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 03/18/2019
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 10/09/2017
• Supplement Date Received by Manufacturer: 06/06/2019
• Initial Report FDA Received Date: 12/07/2017
• Supplement Report FDA Received Date: 06/10/2019
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1
• Patient Age: 88 YR