BEUDAMED
    FDA Adverse Event Death Summary report: N

    MOMENTUM DR DDDRO IS-1 (VS-1) 3.2 BIPOLAR

    MDR report key: 1383146 · Received February 10, 2009

    Report

    Report Number
    2124215-2008-02354
    Event Type
    Death
    Date Received
    February 10, 2009
    Date of Event
    August 27, 2007
    Report Date
    February 10, 2009
    Manufacturer
    GUIDANT ANGLETON/ST. PAUL
    Product Code
    DXY
    Removal / Correction Number
    NA
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Occupation
    INVALID DATA

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 MOMENTUM DR DDDRO IS-1 (VS-1) 3.2 BIPOLAR IMPLANTABLE PULSE GENERATOR DXY GUIDANT ANGLETON/ST. PAUL 294-23 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 87 YR Death