BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    VITALITY 2 VR

    MDR report key: 1114638 · Received August 14, 2008

    Report

    Report Number
    2124215-2008-35650
    Event Type
    Malfunction
    Date Received
    August 14, 2008
    Date of Event
    April 14, 2008
    Report Date
    April 14, 2008
    Manufacturer
    CARDIAC PACEMAKERS, INC
    Product Code
    LWS
    Removal / Correction Number
    Z47/53-08
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    MN, US
    Reporter Occupation
    LAY USER/PATIENT

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 VITALITY 2 VR IMPLANTABLE CARDIOVERTER DEFIBRILLATOR LWS CARDIAC PACEMAKERS, INC T175 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 74 YR Other THE DEVICE 0184/113833 WAS IMPLANTED 14-JUL-2005