BEUDAMED
    FDA Adverse Event Injury Summary report: N

    2017865-2008-01266

    MDR report key: 1050365 · Received May 27, 2008

    Report

    Report Number
    2017865-2008-01266
    Event Type
    Injury
    Date Received
    May 27, 2008
    Date of Event
    December 27, 2007
    Product Code
    DTB
    PMA / PMN Number
    PMA00001
    Removal / Correction Number
    NA
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    IA
    Reporter Occupation
    OTHER HEALTH CARE PROFESSIONAL

    Narratives

    Additional Manufacturer Narrative · 1

    ALL INFORMATION PROVIDED BY MANUFACTURER, NO MEDWATCH FORM WAS RECEIVED.

    Description of Event or Problem · 1

    IT WAS REPORTED THAT THE PATIENT PRESENTED TO THE EMERGENCY ROOM WITH HICCUPS AND DIAPHRAGMATIC STIMULATION. AN X-RAY CONFIRMED LEAD PERFORATION. THE LEAD WAS REPOSITIONED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 DTB

    Patients

    Seq Age Sex Outcome Treatment
    1 Required Intervention