BEUDAMED
    FDA Adverse Event Death Summary report: N

    CAPSURE

    MDR report key: 1242170 · Received November 13, 2008

    Report

    Report Number
    2649622-2008-05200
    Event Type
    Death
    Date Received
    November 13, 2008
    Date of Event
    March 8, 2003
    Manufacturer
    MEDTRONIC PUERTO RICO, INC.
    Product Code
    DTB
    Removal / Correction Number
    NI
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CT
    Reporter Occupation
    INVALID DATA

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 CAPSURE IMPLANTABLE PACING LEAD DTB MEDTRONIC PUERTO RICO, INC. 4003 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 91 YR Other 8427 IMPLANTABLE PULSE GENERATOR