BEUDAMED
    FDA Adverse Event Death Summary report: N

    CAPSUREFIX

    MDR report key: 1013451 · Received March 10, 2008

    Report

    Report Number
    2649622-2008-00897
    Event Type
    Death
    Date Received
    March 10, 2008
    Date of Event
    May 18, 2007
    Manufacturer
    MEDTRONIC PUERTO RICO, INC.
    Product Code
    DTB
    Removal / Correction Number
    NI
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    US
    Reporter Occupation
    UNKNOWN

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 CAPSUREFIX IMPLANTABLE PACING LEAD DTB MEDTRONIC PUERTO RICO, INC. 5068 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 85 YR Death P1501DR IMPLANTABLE PULSE GENERATOR| 5068 IMPLANTABLE PACING LEAD