BEUDAMED
    FDA Adverse Event Injury Summary report: N

    ENDOTAK RELIANCE

    MDR report key: 1043507 · Received May 8, 2008

    Report

    Report Number
    2124215-2008-33140
    Event Type
    Injury
    Date Received
    May 8, 2008
    Date of Event
    January 15, 2008
    Report Date
    January 31, 2008
    Manufacturer
    CARDIAC PACEMAKERS, INC
    Product Code
    LWS
    Removal / Correction Number
    NA
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    UK
    Reporter Occupation
    HEALTH PROFESSIONAL

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ENDOTAK RELIANCE IMPLANTABLE LEAD LWS CARDIAC PACEMAKERS, INC 0138 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 35 YR Required Intervention THE DEVICE 4096/132623 WAS IMPLANTED 15-JAN-2008| THE DEVICE F030/200121 WAS IMPLANTED 15-JAN-2008