BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    SELUTE PICOTIP LEAD

    MDR report key: 1041833 · Received May 8, 2008

    Report

    Report Number
    2124215-2008-34823
    Event Type
    Malfunction
    Date Received
    May 8, 2008
    Date of Event
    March 26, 2008
    Report Date
    March 26, 2008
    Manufacturer
    CARDIAC PACEMAKERS, INC
    Product Code
    DTB
    Removal / Correction Number
    NA
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    MN, US
    Reporter Occupation
    LAY USER/PATIENT

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 SELUTE PICOTIP LEAD IMPLANTABLE LEAD DTB CARDIAC PACEMAKERS, INC 4035 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 78 YR Other THE DEVICE 1290/790999 WAS IMPLANTED 10-SEP-2007| THE DEVICE 4244/417824 WAS IMPLANTED 24-JUL-2000