BEUDAMED
    FDA Adverse Event Injury Summary report: N

    ENDOTAK RELIANCE G

    MDR report key: 1253602 · Received November 11, 2008

    Report

    Report Number
    2124215-2008-40344
    Event Type
    Injury
    Date Received
    November 11, 2008
    Date of Event
    September 9, 2008
    Report Date
    September 9, 2008
    Manufacturer
    CARDIAC PACEMAKERS, INC
    Product Code
    LWS
    Removal / Correction Number
    NA
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    US
    Reporter Occupation
    OTHER HEALTH CARE PROFESSIONAL

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ENDOTAK RELIANCE G IMPLANTABLE LEAD LWS CARDIAC PACEMAKERS, INC 0184 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 58 YR Required Intervention THE DEVICE 4592/109182 WAS IMPLANTED 15-AUG-2008| THE DEVICE 4469/501339 WAS IMPLANTED 15-AUG-2008| THE DEVICE N119/000873 WAS IMPLANTED 15-AUG-2008