FDA Adverse Event
Malfunction
Summary report: N
VITALITY AVT FAST-CHARGE
MDR report key: 1041774
·
Received May 8, 2008
Report
- Report Number
- 2124215-2008-34877
- Event Type
- Malfunction
- Date Received
- May 8, 2008
- Date of Event
- March 27, 2008
- Report Date
- March 27, 2008
- Manufacturer
- CARDIAC PACEMAKERS, INC
- Product Code
- LWS
- Removal / Correction Number
- Z47/53-08
- Product Problem
- Yes
- Report Source
- Manufacturer report
- Reporter Location
- MD, US
- Reporter Occupation
- PHYSICIAN
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 | 78 YR | Other | THE DEVICE T165/137485 WAS IMPLANTED 27-MAR-2008| THE DEVICE 4086/214568 WAS IMPLANTED 08-OCT-2004| THE DEVICE 0184/105554 WAS IMPLANTED 08-OCT-2004 |