BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    ENDEAVOR STENT 2.5MM X 30MM

    MDR report key: 1083462 · Received July 28, 2008

    Report

    Report Number
    MW5007818
    Event Type
    Malfunction
    Date Received
    July 28, 2008
    Date of Event
    June 12, 2008
    Report Date
    July 28, 2008
    Manufacturer
    MEDTRONIC
    Product Code
    NIQ
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    MN, US
    Reporter Occupation
    PHYSICIAN

    Narratives

    Description of Event or Problem · 1

    STENT PULLED FREE FROM CATHETER. NO CLINICAL SEQUALE. DATES OF USE: 2008. DIAGNOSIS OR REASON FOR USE: CAD/ANGINA.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ENDEAVOR STENT 2.5MM X 30MM NONE NIQ MEDTRONIC 0000679530

    Patients

    Seq Age Sex Outcome Treatment
    1 72 YR