FDA Adverse Event
Malfunction
Summary report: N
INSIGNIA ENTRA
MDR report key: 1042230
·
Received May 8, 2008
Report
- Report Number
- 2124215-2008-34409
- Event Type
- Malfunction
- Date Received
- May 8, 2008
- Date of Event
- March 11, 2008
- Report Date
- March 12, 2008
- Manufacturer
- CARDIAC PACEMAKERS, INC
- Product Code
- DXY
- Removal / Correction Number
- NA
- Adverse Event
- Yes
- Product Problem
- Yes
- Report Source
- Manufacturer report
- Reporter Location
- CA
- Reporter Occupation
- PHYSICIAN
Devices
| Seq | Brand | Generic | Product Code | Manufacturer | Model | Lot | UDI-DI |
|---|---|---|---|---|---|---|---|
| 1 | INSIGNIA ENTRA | IMPLANTABLE PULSE GENERATOR | DXY | CARDIAC PACEMAKERS, INC | 1198 | NA |
Patients
| Seq | Age | Sex | Outcome | Treatment |
|---|---|---|---|---|
| 1 | 79 YR | Other | THE DEVICE 1198/144232 WAS IMPLANTED 12-MAR-2008| THE DEVICE 4471/449073 WAS IMPLANTED 11-MAR-2008 |