BEUDAMED
    FDA Adverse Event Injury Summary report: N

    ENDOTAK RELIANCE SG

    MDR report key: 1042062 · Received May 8, 2008

    Report

    Report Number
    2124215-2008-34577
    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
    LWS
    Removal / Correction Number
    NA
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    US
    Reporter Occupation
    OTHER HEALTH CARE PROFESSIONAL

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ENDOTAK RELIANCE SG IMPLANTABLE LEAD LWS CARDIAC PACEMAKERS, INC 0181 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 48 YR Required Intervention THE DEVICE 4554/159087 WAS IMPLANTED 29-FEB-2008| THE DEVICE H210/217367 WAS IMPLANTED 29-FEB-2008| THE DEVICE 4054/458459 WAS IMPLANTED 29-FEB-2008