BEUDAMED
    FDA Adverse Event Death Summary report: N

    NONE

    MDR report key: 1071214 · Received June 27, 2008

    Report

    Report Number
    2649622-2008-03267
    Event Type
    Death
    Date Received
    June 27, 2008
    Date of Event
    March 29, 2007
    Manufacturer
    MEDTRONIC PUERTO RICO, INC.
    Product Code
    DTB
    Removal / Correction Number
    NI
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    FL
    Reporter Occupation
    INVALID DATA

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 NONE IMPLANTABLE PACING LEAD DTB MEDTRONIC PUERTO RICO, INC. 4058M NA

    Patients

    Seq Age Sex Outcome Treatment
    1 88 YR Other 4024 IMPLANTABLE PACING LEAD| 7108 IMPLANTABLE PULSE GENERATOR