BEUDAMED
    FDA Adverse Event Injury Summary report: N

    VITALITY 2 DR

    MDR report key: 1042084 · Received May 8, 2008

    Report

    Report Number
    2124215-2008-34571
    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 VITALITY 2 DR IMPLANTABLE CARDIOVERTER DEFIBRILLATOR LWS CARDIAC PACEMAKERS, INC T165 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 44 YR Required Intervention THE DEVICE 4472/422585 WAS IMPLANTED 04-SEP-2007| THE DEVICE LATR WAS USED DURING THE EVENT.| THE DEVICE 6481 043158 WAS USED DURING THE EVENT.| THE DEVICE 0184/137872 WAS IMPLANTED 04-SEP-2007