BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    *

    MDR report key: 1072251 · Received July 10, 2008

    Report

    Report Number
    2649622-2008-03339
    Event Type
    Malfunction
    Date Received
    July 10, 2008
    Date of Event
    April 18, 2008
    Manufacturer
    MEDTRONIC PUERTO RICO, INC.
    Product Code
    DTB
    Removal / Correction Number
    NI
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    IN
    Reporter Occupation
    INVALID DATA

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 * IMPLANTABLE PACING LEAD DTB MEDTRONIC PUERTO RICO, INC. 5071 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 83 YR Required Intervention 4076 IMPLANTABLE PACING LEAD| 7299 IMPLANTABLE PACEMAKER/CARDIO/DEFIB| 6949 IMPLANTABLE TACHY LEAD