BEUDAMED
    FDA Adverse Event Injury Summary report: N

    ENDOTAK RELIANCE

    MDR report key: 1041515 · Received May 8, 2008

    Report

    Report Number
    2124215-2008-32016
    Event Type
    Injury
    Date Received
    May 8, 2008
    Date of Event
    November 17, 2007
    Report Date
    March 5, 2008
    Manufacturer
    CARDIAC PACEMAKERS, INC
    Product Code
    LWS
    Removal / Correction Number
    NA
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CA
    Reporter Occupation
    OTHER HEALTH CARE PROFESSIONAL

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ENDOTAK RELIANCE IMPLANTABLE LEAD LWS CARDIAC PACEMAKERS, INC 0158 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 45 YR Required Intervention THE DEVICE H195/304604 WAS IMPLANTED 18-NOV-2004| THE DEVICE 4087/171613 WAS IMPLANTED 18-NOV-2004| THE DEVICE 4518/301090 WAS IMPLANTED 18-NOV-2004