BEUDAMED
    FDA Adverse Event Injury Summary report: N

    NONE

    MDR report key: 1013572 · Received March 10, 2008

    Report

    Report Number
    2649622-2008-00851
    Event Type
    Injury
    Date Received
    March 10, 2008
    Date of Event
    May 2, 2007
    Manufacturer
    MEDTRONIC PUERTO RICO, INC.
    Product Code
    DTB
    Removal / Correction Number
    NI
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    WI
    Reporter Occupation
    INVALID DATA

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 NONE IMPLANTABLE PACING LEAD DTB MEDTRONIC PUERTO RICO, INC. 4058M NA

    Patients

    Seq Age Sex Outcome Treatment
    1 88 YR Required Intervention 4558M IMPLANTABLE PACING LEAD| 7960IB IMPLANTABLE PULSE GENERATOR