MAUDE Adverse Event Report: PLEXUS MANUFACTURING SDN. BHD MEDTRONIC CARELINK MONITOR (PATIENT HOME MONITOR); PULSE GENERATOR, PERMANENT, IMPLANTABLE

Model Number	2490H10
Medical Device Problem Code	Overheating of Device (1437)
Health Effect - Clinical Code	No Known Impact Or Consequence To Patient (2692)
Date of Event	05/20/2019
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 while on the phone, the patient stated that the monitor or cord exploded.No troubleshooting indicated.The monitor status was unknown.No patient complications have been reported as a result of this event.
Additional Manufacturer Narrative
Product analysis: model: 2490h10, serial/lot#: (b)(4): the remote monitor was returned and the analysis revealed that no defect was found.If information is provided in the future, a supplemental report will be issued.
Event or Problem Description
The monitor was returned and replaced.

• Brand Name: MEDTRONIC CARELINK MONITOR (PATIENT HOME MONITOR)
• 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: 8652676
• Report Number: 3004593495-2019-00501
• Device Sequence Number: 11404672
• Product Code: NVZ
• UDI-Device Identifier: 00643169341074
• UDI-Public: 00643169341074
• Combination Product (Y/N): N
• Initial Reporter State: NC
• 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: Non-Healthcare Professional
• Type of Report: Initial,Followup
• Report Date (Section B): 08/28/2019

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: 2490H10
• Device Catalogue Number: 2490H10
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 07/16/2019
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 05/28/2019
• Supplement Date Received by Manufacturer: 08/23/2019
• Initial Report FDA Received Date: 05/30/2019
• Supplement Report FDA Received Date: 08/29/2019
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1
• Patient Age: 79 YR