BEUDAMED
    FDA Adverse Event Death Summary report: N

    CAPSUREFIX

    MDR report key: 1153023 · Received September 3, 2008

    Report

    Report Number
    2649622-2008-04046
    Event Type
    Death
    Date Received
    September 3, 2008
    Date of Event
    March 29, 2006
    Manufacturer
    MEDTRONIC PUERTO RICO, INC.
    Product Code
    DTB
    Removal / Correction Number
    NI
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    FL
    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 93 YR Other 4024 IMPLANTABLE PACING LEAD| KDR701 IMPLANTABLE PULSE GENERATOR