BEUDAMED
    FDA Adverse Event Injury Summary report: N

    CAPSUREFIX

    MDR report key: 1140569 · Received August 29, 2008

    Report

    Report Number
    2649622-2008-04045
    Event Type
    Injury
    Date Received
    August 29, 2008
    Date of Event
    October 9, 1996
    Manufacturer
    MEDTRONIC PUERTO RICO, INC.
    Product Code
    DTB
    Removal / Correction Number
    NI
    Report Source
    Manufacturer report
    Reporter Location
    TX
    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 13 YR Required Intervention 4068 IMPLANTABLE PACING LEAD| 7950B IMPLANTABLE PULSE GENERATOR