BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    LD CV EZTRK 2 BP IS1 4543 90CM US

    MDR report key: 1042911 · Received May 8, 2008

    Report

    Report Number
    2124215-2008-33745
    Event Type
    Malfunction
    Date Received
    May 8, 2008
    Date of Event
    February 21, 2008
    Report Date
    February 21, 2008
    Manufacturer
    CARDIAC PACEMAKERS, INC
    Product Code
    DTB
    Removal / Correction Number
    NA
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    US
    Reporter Occupation
    LAY USER/PATIENT

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 LD CV EZTRK 2 BP IS1 4543 90CM US IMPLANTABLE LEAD DTB CARDIAC PACEMAKERS, INC 4543 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 70 YR Other THE DEVICE H177/506824 WAS IMPLANTED 14-APR-2005| THE DEVICE 0185/119932 WAS IMPLANTED 14-APR-2005| THE DEVICE 6481 044339 WAS USED DURING THE EVENT.