BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    CONTAK RENEWAL 3 RF

    MDR report key: 1041741 · Received May 8, 2008

    Report

    Report Number
    2124215-2008-34900
    Event Type
    Malfunction
    Date Received
    May 8, 2008
    Date of Event
    March 28, 2008
    Report Date
    March 28, 2008
    Manufacturer
    CARDIAC PACEMAKERS, INC
    Product Code
    NIK
    Removal / Correction Number
    Z-0863-05
    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 CONTAK RENEWAL 3 RF IMPLANTABLE CHF GENERATOR NIK CARDIAC PACEMAKERS, INC H215 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 78 YR Other THE DEVICE 4524/160201 WAS IMPLANTED 08-NOV-2006| THE DEVICE 6483 506010 WAS USED DURING THE EVENT.| THE DEVICE 0184/128934 WAS IMPLANTED 08-NOV-2006| THE DEVICE 4473/445007 WAS IMPLANTED 08-NOV-2006| THE DEVICE 6487 505100 WAS USED DURING THE EVENT.| THE DEVICE 6482 006952 WAS USED DURING THE EVENT.