BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    MEDTRONIC, INC

    MDR report key: 1026943 · Received April 8, 2008

    Report

    Report Number
    MW5006159
    Event Type
    Malfunction
    Date Received
    April 8, 2008
    Date of Event
    December 31, 2007
    Report Date
    April 8, 2008
    Manufacturer
    MEDTRONIC, INC
    Product Code
    DQO
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    MO, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    MARKER BEAD FROM 6 FRENCH MEDTRONIC EXPORT CATHETER DISLODGED FROM CATHETER. REMAINS IN CIRCUMFLEX ARTERY USED BY CARDIOLOGIST

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 MEDTRONIC, INC 6 FR EXPORT CATHETER DQO MEDTRONIC, INC EXPORT XT UNK

    Patients

    Seq Age Sex Outcome Treatment
    1 65 YR