BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    VENTAK PRIZM 2 DR

    MDR report key: 1253980 · Received November 11, 2008

    Report

    Report Number
    2124215-2008-40823
    Event Type
    Malfunction
    Date Received
    November 11, 2008
    Date of Event
    September 23, 2008
    Report Date
    September 23, 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 VENTAK PRIZM 2 DR IMPLANTABLE CARDIOVERTER DEFIBRILLATOR LWS CARDIAC PACEMAKERS, INC 1861 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 72 YR Other THE DEVICE 4269/310222 WAS IMPLANTED 06-AUG-1998| THE DEVICE 0125/310483 WAS IMPLANTED 06-AUG-1998