BEUDAMED
    FDA Adverse Event Injury Summary report: N

    RELIANCE G ACTIVE FIX DUAL COIL 59CM

    MDR report key: 1683617 · Received May 7, 2010

    Report

    Report Number
    2124215-2010-05163
    Event Type
    Injury
    Date Received
    May 7, 2010
    Date of Event
    February 24, 2010
    Report Date
    May 7, 2010
    Manufacturer
    CPI - DEL CARIBE
    Product Code
    LWS
    Removal / Correction Number
    NA
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    WY, US
    Reporter Occupation
    INVALID DATA

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 RELIANCE G ACTIVE FIX DUAL COIL 59CM IMPLANTABLE LEAD LWS CPI - DEL CARIBE 0184 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 66 YR Other