BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    ENDOTAK RELIANCE G

    MDR report key: 1041992 · Received May 8, 2008

    Report

    Report Number
    2124215-2008-34647
    Event Type
    Malfunction
    Date Received
    May 8, 2008
    Date of Event
    March 20, 2008
    Report Date
    March 20, 2008
    Manufacturer
    CARDIAC PACEMAKERS, INC
    Product Code
    LWS
    Removal / Correction Number
    NA
    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 ENDOTAK RELIANCE G IMPLANTABLE LEAD LWS CARDIAC PACEMAKERS, INC 0184 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 72 YR Other THE DEVICE T165/104777 WAS IMPLANTED 27-JUL-2005| THE DEVICE 4472/416159 WAS IMPLANTED 27-JUL-2005| THE DEVICE 4473/302579 WAS IMPLANTED 03-DEC-2001