BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    UNKNOWN

    MDR report key: 17519064 · Received August 12, 2023

    Report

    Report Number
    MW5126012
    Event Type
    Malfunction
    Date Received
    August 12, 2023
    Report Date
    November 3, 2011
    Manufacturer
    MEDTRONIC
    Product Code
    DTB
    Report Source
    Voluntary report
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 0

    TECHNICAL SERVICES RECEIVED A CALL ON 10/25/2011 FROM SALES REP. THE LEAD WAS EXPLANTED ON (B)(6) 2011. DUE TO THE LEAD FRACTURED. NO PHYSICIAN OR HOSPITAL KNOWN. THIS REPORT REFLECTS INFORMATION RECEIVED BY FDA IN THE FORM OF A NOTIFICATION PER 803.22 (B)(2).

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    870037 UNKNOWN PERMANENT PACEMAKER ELECTRODE DTB MEDTRONIC 6943

    Patients

    Seq Age Sex Outcome Treatment
    1 Unknown