FDA Adverse Event
Injury
Summary report: N
CONTAK RENEWAL 3
MDR report key: 1041886
·
Received May 8, 2008
Report
- Report Number
- 2124215-2008-34765
- Event Type
- Injury
- Date Received
- May 8, 2008
- Date of Event
- March 25, 2008
- Report Date
- March 25, 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 | H170 | NA |
Patients
| Seq | Age | Sex | Outcome | Treatment |
|---|---|---|---|---|
| 1 | 83 YR | Required Intervention | THE DEVICE 4024/LAJ233 WAS IMPLANTED 07-MAR-1997| THE DEVICE 6949 LFJ126 WAS USED DURING THE EVENT.| THE DEVICE 4549/152647 WAS IMPLANTED 21-MAR-2006| THE DEVICE 4524/LAR107 WAS IMPLANTED 07-MAR-1997 |