FDA Adverse Event
Malfunction
Summary report: N
VITALITY DS
MDR report key: 1042352
·
Received May 8, 2008
Report
- Report Number
- 2124215-2008-34279
- Event Type
- Malfunction
- 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
- Z47/53-08
- 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 DS | IMPLANTABLE CARDIOVERTER DEFIBRILLATOR | LWS | CARDIAC PACEMAKERS, INC | T125 | NA |
Patients
| Seq | Age | Sex | Outcome | Treatment |
|---|---|---|---|---|
| 1 | 53 YR | Other | THE DEVICE 1270/653165 WAS IMPLANTED 31-JAN-2001| THE DEVICE 4453/203270 WAS IMPLANTED 31-JAN-2001| THE DEVICE 0185/115110 WAS IMPLANTED 16-FEB-2005| THE DEVICE 4064/301194 WAS IMPLANTED 31-JAN-2001 |