BEUDAMED
    FDA Adverse Event Injury Summary report: N

    ENDOTAK RELIANCE

    MDR report key: 1042190 · Received May 8, 2008

    Report

    Report Number
    2124215-2008-34453
    Event Type
    Injury
    Date Received
    May 8, 2008
    Date of Event
    March 11, 2008
    Report Date
    March 11, 2008
    Manufacturer
    CARDIAC PACEMAKERS, INC
    Product Code
    LWS
    Removal / Correction Number
    NA
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    FL, US
    Reporter Occupation
    PHYSICIAN

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ENDOTAK RELIANCE IMPLANTABLE LEAD LWS CARDIAC PACEMAKERS, INC 0158 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 44 YR Required Intervention THE DEVICE T165/139779 WAS IMPLANTED 11-MAR-2008| THE DEVICE 4086/207886 WAS IMPLANTED 01-APR-2004| THE DEVICE 0185/191719 WAS IMPLANTED 11-MAR-2008| THE DEVICE T125/101271 WAS IMPLANTED 01-APR-2004