BEUDAMED
    FDA Adverse Event Injury Summary report: N

    SINGLE-PASS

    MDR report key: 1043273 · Received May 8, 2008

    Report

    Report Number
    2124215-2008-33381
    Event Type
    Injury
    Date Received
    May 8, 2008
    Date of Event
    February 8, 2008
    Report Date
    February 8, 2008
    Manufacturer
    CARDIAC PACEMAKERS, INC
    Product Code
    DTB
    Removal / Correction Number
    NA
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CA, US
    Reporter Occupation
    PHYSICIAN

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 SINGLE-PASS IMPLANTABLE LEAD DTB CARDIAC PACEMAKERS, INC 425-04 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 74 YR Required Intervention THE DEVICE 292-/106543 WAS IMPLANTED 18-AUG-1997