FDA Adverse Event
Malfunction
Summary report: N
VITALITY DS VR
MDR report key: 1042809
·
Received May 8, 2008
Report
- Report Number
- 2124215-2008-33840
- Event Type
- Malfunction
- Date Received
- May 8, 2008
- Date of Event
- February 25, 2008
- Report Date
- February 25, 2008
- Manufacturer
- CARDIAC PACEMAKERS, INC
- Product Code
- LWS
- Removal / Correction Number
- Z47/53-08
- Product Problem
- Yes
- Report Source
- Manufacturer report
- Reporter Location
- MN, US
- Reporter Occupation
- LAY USER/PATIENT
Devices
| Seq | Brand | Generic | Product Code | Manufacturer | Model | Lot | UDI-DI |
|---|---|---|---|---|---|---|---|
| 1 | VITALITY DS VR | IMPLANTABLE CARDIOVERTER DEFIBRILLATOR | LWS | CARDIAC PACEMAKERS, INC | T135 | NA |
Patients
| Seq | Age | Sex | Outcome | Treatment |
|---|---|---|---|---|
| 1 | 69 YR | Other | THE DEVICE 0115/200976 WAS IMPLANTED 27-JUL-1995| THE DEVICE 1790/107361 WAS IMPLANTED 03-FEB-2000| THE DEVICE 1720/252563 WAS IMPLANTED 27-JUL-1995 |