BEUDAMED
    FDA Adverse Event Injury Summary report: N

    6000030-2010-06059

    MDR report key: 1804017 · Received August 12, 2010

    Report

    Report Number
    6000030-2010-06059
    Event Type
    Injury
    Date Received
    August 12, 2010
    Date of Event
    May 25, 2010
    Report Date
    July 15, 2010
    Manufacturer
    RICE CREEK MANUFACTURING
    PMA / PMN Number
    P860004
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Occupation
    NOT APPLICABLE
    Health Professional
    N

    Patients

    Seq Age Sex Outcome Treatment
    1 Male Required Intervention| H CATHETER MODEL 8703W LOT# L50057 | IMPLANTED:(B)(6) 2010