BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    VENTAK PRIZM HE DR

    MDR report key: 1043034 · Received May 8, 2008

    Report

    Report Number
    2124215-2008-33607
    Event Type
    Malfunction
    Date Received
    May 8, 2008
    Date of Event
    February 18, 2008
    Report Date
    March 19, 2008
    Manufacturer
    CARDIAC PACEMAKERS, INC
    Product Code
    LWS
    Removal / Correction Number
    NA
    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 VENTAK PRIZM HE DR IMPLANTABLE CARDIOVERTER DEFIBRILLATOR LWS CARDIAC PACEMAKERS, INC 1853 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 50 YR Other THE DEVICE 1861/204120 WAS IMPLANTED 21-FEB-2001| THE DEVICE 4017/BIQ225 WAS IMPLANTED 21-FEB-2001| THE DEVICE 0155/344368 WAS IMPLANTED 21-FEB-2001