BEUDAMED
    FDA Adverse Event Injury Summary report: N

    DISCOVERY DR

    MDR report key: 1042061 · Received May 8, 2008

    Report

    Report Number
    2124215-2008-34576
    Event Type
    Injury
    Date Received
    May 8, 2008
    Date of Event
    March 19, 2008
    Report Date
    March 19, 2008
    Manufacturer
    CARDIAC PACEMAKERS, INC
    Product Code
    DXY
    Removal / Correction Number
    Z1032-39/5
    Adverse Event
    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 DISCOVERY DR IMPLANTABLE PULSE GENERATOR DXY CARDIAC PACEMAKERS, INC 1273 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 84 YR Required Intervention THE DEVICE 4034/209538 WAS IMPLANTED 21-JUL-1999| THE DEVICE 4053/400411 WAS IMPLANTED 21-JUL-1999