BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    EASYTRAK 2

    MDR report key: 1041655 · Received May 8, 2008

    Report

    Report Number
    2124215-2008-34981
    Event Type
    Malfunction
    Date Received
    May 8, 2008
    Date of Event
    March 31, 2008
    Report Date
    March 31, 2008
    Manufacturer
    CARDIAC PACEMAKERS, INC
    Product Code
    DTB
    Removal / Correction Number
    NA
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    IN
    Reporter Occupation
    PHYSICIAN

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 EASYTRAK 2 IMPLANTABLE LEAD DTB CARDIAC PACEMAKERS, INC 4517 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 61 YR Other THE DEVICE 0165/104273 WAS IMPLANTED 23-MAY-2005| THE DEVICE H155/301692 WAS IMPLANTED 23-MAY-2005