BEUDAMED
    FDA Adverse Event Injury Summary report: N

    CAPSURE EPI

    MDR report key: 1072125 · Received July 10, 2008

    Report

    Report Number
    2182208-2008-00233
    Event Type
    Injury
    Date Received
    July 10, 2008
    Date of Event
    May 29, 2008
    Manufacturer
    MEDTRONIC, INC.
    Product Code
    DTB
    Removal / Correction Number
    NI
    Report Source
    Manufacturer report
    Reporter Location
    SF
    Reporter Occupation
    PHYSICIAN

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 CAPSURE EPI IMPLANTABLE PACING LEAD DTB MEDTRONIC, INC. 4968 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 63 YR Required Intervention