BEUDAMED
    FDA Adverse Event Injury Summary report: N

    LD CV EZTRK 2 BP IS1 4543 90CM US

    MDR report key: 1253972 · Received November 11, 2008

    Report

    Report Number
    2124215-2008-40796
    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
    LWP
    Removal / Correction Number
    NA
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    ME, US
    Reporter Occupation
    PHYSICIAN

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 LD CV EZTRK 2 BP IS1 4543 90CM US IMPLANTABLE LEAD LWP CARDIAC PACEMAKERS, INC 4543 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 78 YR Required Intervention THE DEVICE 0158/163818 WAS IMPLANTED 30-NOV-2006| THE DEVICE 4457/501166 WAS IMPLANTED 13-MAR-2006| THE DEVICE T165/122227 WAS IMPLANTED 30-NOV-2006