FDA Adverse Event
Malfunction
Summary report: N
CONTAK RENEWAL
MDR report key: 1042475
·
Received May 8, 2008
Report
- Report Number
- 2124215-2008-34166
- Event Type
- Malfunction
- Date Received
- May 8, 2008
- Date of Event
- March 3, 2008
- Report Date
- March 3, 2008
- Manufacturer
- CARDIAC PACEMAKERS, INC
- Product Code
- NIK
- Removal / Correction Number
- Z0907/8-05
- Product Problem
- Yes
- Report Source
- Manufacturer report
- Reporter Location
- IS
- Reporter Occupation
- PHYSICIAN
Devices
| Seq | Brand | Generic | Product Code | Manufacturer | Model | Lot | UDI-DI |
|---|---|---|---|---|---|---|---|
| 1 | CONTAK RENEWAL | IMPLANTABLE CHF GENERATOR | NIK | CARDIAC PACEMAKERS, INC | H135 | NA |
Patients
| Seq | Age | Sex | Outcome | Treatment |
|---|---|---|---|---|
| 1 | 85 YR | Other | THE DEVICE 4096/106080 WAS IMPLANTED 17-MAR-2004| THE DEVICE 0175/102426 WAS IMPLANTED 17-MAR-2004| THE DEVICE H199/322426 WAS IMPLANTED 04-MAR-2008 |