BEUDAMED
    FDA Adverse Event Injury Summary report: N

    MEDTRONIC

    MDR report key: 1276943 · Received January 2, 2009

    Report

    Report Number
    1276943
    Event Type
    Injury
    Date Received
    January 2, 2009
    Date of Event
    November 5, 2008
    Report Date
    November 17, 2008
    Manufacturer
    MEDTRONIC
    Product Code
    EZW
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    AR, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    PHYSICIAN STATES PLACED IN 2004. STOPPED WORKING A COUPLE OF MONTHS AGO AND INSTRUCTED TO HAVE IT REPLACED. REPLACEMENT OF DEVICE WAS COORDINATED WITH PATIENT SHOULDER SURGERY.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 MEDTRONIC INTERSTIM EZW MEDTRONIC 3023

    Patients

    Seq Age Sex Outcome Treatment
    1 80 YR Hospitalization