BEUDAMED
    FDA Adverse Event Injury Summary report: N

    CAPSURE EPI

    MDR report key: 1200684 · Received October 7, 2008

    Report

    Report Number
    2182208-2008-00302
    Event Type
    Injury
    Date Received
    October 7, 2008
    Date of Event
    August 22, 2008
    Manufacturer
    MEDTRONIC, INC.
    Product Code
    DTB
    Removal / Correction Number
    NI
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    OK
    Reporter Occupation
    INVALID DATA

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 CAPSURE EPI IMPLANTABLE PACING LEAD DTB MEDTRONIC, INC. 4965 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 10 YR Other| R SESR01 IMPLANTABLE PULSE GENERATOR