BEUDAMED
    FDA Adverse Event Injury Summary report: N

    INSIGNIA PLUS

    MDR report key: 1253798 · Received November 11, 2008

    Report

    Report Number
    2124215-2008-40682
    Event Type
    Injury
    Date Received
    November 11, 2008
    Date of Event
    September 18, 2008
    Report Date
    September 18, 2008
    Manufacturer
    CARDIAC PACEMAKERS, INC
    Product Code
    DXY
    Removal / Correction Number
    NA
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    MN, US
    Reporter Occupation
    LAY USER/PATIENT

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 INSIGNIA PLUS IMPLANTABLE PULSE GENERATOR DXY CARDIAC PACEMAKERS, INC 1298 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 78 YR Required Intervention