BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    DISCOVERY SR

    MDR report key: 1041520 · Received May 8, 2008

    Report

    Report Number
    2124215-2008-32021
    Event Type
    Malfunction
    Date Received
    May 8, 2008
    Date of Event
    October 7, 2005
    Report Date
    January 10, 2008
    Manufacturer
    CARDIAC PACEMAKERS, INC
    Product Code
    DXY
    Removal / Correction Number
    Z1032-39/5
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    SZ
    Reporter Occupation
    NURSE

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 DISCOVERY SR IMPLANTABLE PULSE GENERATOR DXY CARDIAC PACEMAKERS, INC 1174 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 77 YR Other