BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    PULSAR MAX II

    MDR report key: 1043248 · Received May 8, 2008

    Report

    Report Number
    2124215-2008-33385
    Event Type
    Malfunction
    Date Received
    May 8, 2008
    Date of Event
    February 5, 2008
    Report Date
    February 5, 2008
    Manufacturer
    CARDIAC PACEMAKERS, INC
    Product Code
    DXY
    Removal / Correction Number
    NA
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    JA
    Reporter Occupation
    PHYSICIAN

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 PULSAR MAX II IMPLANTABLE PULSE GENERATOR DXY CARDIAC PACEMAKERS, INC 1180 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 91 YR Other THE DEVICE 4459/312830 WAS IMPLANTED 04-SEP-2003