BEUDAMED
    FDA Adverse Event Injury Summary report: N

    GEM III AT

    MDR report key: 1013561 · Received March 10, 2008

    Report

    Report Number
    2647346-2008-00073
    Event Type
    Injury
    Date Received
    March 10, 2008
    Date of Event
    September 21, 2006
    Manufacturer
    MEDTRONIC MED REL, INC.
    Product Code
    LWS
    Removal / Correction Number
    NI
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    IN
    Reporter Occupation
    INVALID DATA

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 GEM III AT IMPLANTABLE PACEMAKER/CARDIO/DEFIB LWS MEDTRONIC MED REL, INC. 7276 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 87 YR Other 5076 IMPLANTABLE PACING LEAD| 6947 IMPLANTABLE TACHY LEAD