BEUDAMED
    FDA Adverse Event Death Summary report: N

    NONE

    MDR report key: 1071215 · Received June 27, 2008

    Report

    Report Number
    2649622-2008-03269
    Event Type
    Death
    Date Received
    June 27, 2008
    Date of Event
    May 26, 2005
    Manufacturer
    MEDTRONIC PUERTO RICO, INC.
    Product Code
    DTB
    Removal / Correction Number
    NI
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    MN
    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 64 YR Other 8340 IMPLANTABLE PULSE GENERATOR