BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    ENDOTAK RELIANCE G

    MDR report key: 1043517 · Received May 8, 2008

    Report

    Report Number
    2124215-2008-33122
    Event Type
    Malfunction
    Date Received
    May 8, 2008
    Date of Event
    February 4, 2008
    Report Date
    February 4, 2008
    Manufacturer
    CARDIAC PACEMAKERS, INC
    Product Code
    LWS
    Removal / Correction Number
    NA
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    MN, US
    Reporter Occupation
    LAY USER/PATIENT

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ENDOTAK RELIANCE G IMPLANTABLE LEAD LWS CARDIAC PACEMAKERS, INC 0184 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 54 YR Other THE DEVICE 6481 307896 WAS USED DURING THE EVENT.| THE DEVICE T175/113055 WAS IMPLANTED 28-APR-2006| THE DEVICE LATR WAS USED DURING THE EVENT.