FDA Adverse Event
Malfunction
Summary report: N
CONTAK RENEWAL 3
MDR report key: 1041849
·
Received May 8, 2008
Report
- Report Number
- 2124215-2008-34784
- 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
- NIK
- Removal / Correction Number
- Z47/55-07
- 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 | CONTAK RENEWAL 3 | IMPLANTABLE CHF GENERATOR | NIK | CARDIAC PACEMAKERS, INC | H179 | NA |
Patients
| Seq | Age | Sex | Outcome | Treatment |
|---|---|---|---|---|
| 1 | 73 YR | Other | THE DEVICE H155/203171 WAS IMPLANTED 15-JUL-2003| THE DEVICE 0158/119406 WAS IMPLANTED 31-JUL-2003| THE DEVICE H219/206319 WAS IMPLANTED 26-MAR-2008| THE DEVICE 4086/159070 WAS IMPLANTED 31-JUL-2003| THE DEVICE 4518/202698 WAS IMPLANTED 31-JUL-2003 |