BEUDAMED
    FDA Adverse Event Injury Summary report: N

    *

    MDR report key: 1072409 · Received July 10, 2008

    Report

    Report Number
    2649622-2008-03662
    Event Type
    Injury
    Date Received
    July 10, 2008
    Date of Event
    November 14, 2007
    Manufacturer
    MEDTRONIC PUERTO RICO, INC.
    Product Code
    DTB
    Removal / Correction Number
    NI
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    IL
    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 80 YR Required Intervention 5076 IMPLANTABLE PACING LEAD| 6948 IMPLANTABLE TACHY LEAD| 7289 IMPLANTABLE PACEMAKER/CARDIO/DEFIB