BEUDAMED
    FDA Adverse Event Injury Summary report: N

    2017865-2008-01730

    MDR report key: 1050778 · Received May 27, 2008

    Report

    Report Number
    2017865-2008-01730
    Event Type
    Injury
    Date Received
    May 27, 2008
    Date of Event
    February 15, 2008
    Product Code
    LWS
    PMA / PMN Number
    PMA00001
    Removal / Correction Number
    NA
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    SC
    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 LEAD EXHIBITED NOISE THAT WAS INTERPRETED AS VENTRICULAR FIBRILLATION. THE PATIENT RECEIVED INAPPROPRIATE HV THERAPY. CHEST X-RAY WAS RECOMMENDED. THE LEAD WAS CAPPED.

    Devices

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

    Patients

    Seq Age Sex Outcome Treatment
    1 Required Intervention