BEUDAMED
    FDA Adverse Event Injury Summary report: N

    CAPSUREFIX

    MDR report key: 1072332 · Received July 10, 2008

    Report

    Report Number
    2649622-2008-03352
    Event Type
    Injury
    Date Received
    July 10, 2008
    Date of Event
    July 16, 2007
    Manufacturer
    MEDTRONIC PUERTO RICO, INC.
    Product Code
    DTB
    Removal / Correction Number
    NI
    Report Source
    Manufacturer report
    Reporter Location
    MI
    Reporter Occupation
    INVALID DATA

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 CAPSUREFIX IMPLANTABLE PACING LEAD DTB MEDTRONIC PUERTO RICO, INC. 4068 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 61 YR Required Intervention E2DR01 IMPLANTABLE PULSE GENERATOR| 4068 IMPLANTABLE PACING LEAD