BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    CONTAK RENEWAL 3

    MDR report key: 1254105 · Received November 11, 2008

    Report

    Report Number
    2124215-2008-40923
    Event Type
    Malfunction
    Date Received
    November 11, 2008
    Date of Event
    September 25, 2008
    Report Date
    September 25, 2008
    Manufacturer
    CARDIAC PACEMAKERS, INC
    Product Code
    NIK
    Removal / Correction Number
    Z47/53-08
    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 CONTAK RENEWAL 3 IMPLANTABLE CHF GENERATOR NIK CARDIAC PACEMAKERS, INC H170 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 81 YR Other THE DEVICE 4193/BAA074 WAS IMPLANTED 30-APR-2004| THE DEVICE 4470/423799 WAS IMPLANTED 30-APR-2004| THE DEVICE 0157/123201 WAS IMPLANTED 30-APR-2004