BEUDAMED
    FDA Adverse Event Injury Summary report: N

    SELUTE PICOTIP

    MDR report key: 1042844 · Received May 8, 2008

    Report

    Report Number
    2124215-2008-33791
    Event Type
    Injury
    Date Received
    May 8, 2008
    Date of Event
    February 22, 2008
    Report Date
    February 22, 2008
    Manufacturer
    CARDIAC PACEMAKERS, INC
    Product Code
    DTB
    Removal / Correction Number
    NA
    Adverse Event
    Yes
    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 SELUTE PICOTIP IMPLANTABLE LEAD DTB CARDIAC PACEMAKERS, INC 4034 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 78 YR Required Intervention THE DEVICE 1290/805230 WAS IMPLANTED 15-FEB-2008| THE DEVICE 4034/ WAS IMPLANTED| THE DEVICE 4054/454527 WAS IMPLANTED 15-FEB-2008