BEUDAMED
    FDA Adverse Event Injury Summary report: N

    VITALITY AVT FAST-CHARGE

    MDR report key: 1041519 · Received May 8, 2008

    Report

    Report Number
    2124215-2008-32020
    Event Type
    Injury
    Date Received
    May 8, 2008
    Date of Event
    November 25, 2007
    Report Date
    March 25, 2008
    Manufacturer
    CARDIAC PACEMAKERS, INC
    Product Code
    LWS
    Removal / Correction Number
    Z47/53-08
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    US
    Reporter Occupation
    OTHER HEALTH CARE PROFESSIONAL

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 VITALITY AVT FAST-CHARGE IMPLANTABLE CARDIOVERTER DEFIBRILLATOR LWS CARDIAC PACEMAKERS, INC A155 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 63 YR Required Intervention THE DEVICE 0148/141215 WAS IMPLANTED 13-FEB-2004| THE DEVICE 4087/207432 WAS IMPLANTED 13-FEB-2004