BEUDAMED
    FDA Adverse Event Injury Summary report: N

    DA+ C SERIES SR

    MDR report key: 1013479 · Received March 10, 2008

    Report

    Report Number
    2649622-2008-00879
    Event Type
    Injury
    Date Received
    March 10, 2008
    Date of Event
    November 12, 2007
    Manufacturer
    MEDTRONIC PUERTO RICO, INC.
    Product Code
    DXY
    Removal / Correction Number
    NI
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    AU
    Reporter Occupation
    PHYSICIAN

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 DA+ C SERIES SR IMPLANTABLE PULSE GENERATOR DXY MEDTRONIC PUERTO RICO, INC. C20A3 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 Required Intervention