BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    NONE

    MDR report key: 1072354 · Received July 10, 2008

    Report

    Report Number
    2182208-2008-00243
    Event Type
    Malfunction
    Date Received
    July 10, 2008
    Date of Event
    May 13, 2008
    Manufacturer
    MEDTRONIC, INC.
    Product Code
    LWS
    Removal / Correction Number
    NI
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    PA
    Reporter Occupation
    INVALID DATA

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 NONE PERMANENT LEAD EXTENSION LWS MEDTRONIC, INC. 6984M NA

    Patients

    Seq Age Sex Outcome Treatment
    1 79 YR Required Intervention 4568 IMPLANTABLE PACING LEAD| SDR303 IMPLANTABLE PULSE GENERATOR