BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    LD CV EZTRK 2 BP IS1 4542 80CM US

    MDR report key: 1254192 · Received November 11, 2008

    Report

    Report Number
    2124215-2008-41021
    Event Type
    Malfunction
    Date Received
    November 11, 2008
    Date of Event
    August 4, 2008
    Report Date
    August 4, 2008
    Manufacturer
    CARDIAC PACEMAKERS, INC
    Product Code
    LWP
    Removal / Correction Number
    NA
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    NJ, US
    Reporter Occupation
    PHYSICIAN

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 LD CV EZTRK 2 BP IS1 4542 80CM US IMPLANTABLE LEAD LWP CARDIAC PACEMAKERS, INC 4542 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 92 YR Other THE DEVICE 4543/139003 WAS IMPLANTED 04-AUG-2008| THE DEVICE UNKN/ WAS IMPLANTED| THE DEVICE UNKN/ WAS IMPLANTED 04-AUG-2008