BEUDAMED
    FDA Adverse Event Injury Summary report: N

    EASYTRAK 2 LVA DUAL ELECTRODE IS-1 PASSIVE 90CM

    MDR report key: 1704839 · Received May 21, 2010

    Report

    Report Number
    2124215-2010-10139
    Event Type
    Injury
    Date Received
    May 21, 2010
    Date of Event
    April 29, 2010
    Report Date
    May 21, 2010
    Manufacturer
    CPI - DEL CARIBE
    Product Code
    LWP
    Removal / Correction Number
    NA
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    NY, US
    Reporter Occupation
    INVALID DATA

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 EASYTRAK 2 LVA DUAL ELECTRODE IS-1 PASSIVE 90CM IMPLANTABLE LEAD LWP CPI - DEL CARIBE 4543 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 74 YR Required Intervention