BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    CONTAK RENEWAL 3

    MDR report key: 1041509 · Received May 8, 2008

    Report

    Report Number
    2124215-2008-32038
    Event Type
    Malfunction
    Date Received
    May 8, 2008
    Date of Event
    December 13, 2007
    Report Date
    January 22, 2008
    Manufacturer
    CARDIAC PACEMAKERS, INC
    Product Code
    NIK
    Removal / Correction Number
    Z47/55-07
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    MN, US
    Reporter Occupation
    LAY USER/PATIENT

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 CONTAK RENEWAL 3 IMPLANTABLE CHF GENERATOR NIK CARDIAC PACEMAKERS, INC H175 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 66 YR Other THE DEVICE 4471/410759 WAS IMPLANTED 29-APR-2004| THE DEVICE 4513/314970 WAS IMPLANTED 05-AUG-2003| THE DEVICE 0158/120869 WAS IMPLANTED 05-AUG-2003