BEUDAMED
    FDA Adverse Event Injury Summary report: N

    COROX OTW-S 75-BP

    MDR report key: 2212957 · Received August 5, 2011

    Report

    Report Number
    1028232-2011-01751
    Event Type
    Injury
    Date Received
    August 5, 2011
    Date of Event
    January 3, 2011
    Report Date
    July 26, 2011
    Manufacturer
    BIOTRONIK SE & CO KG
    Product Code
    NKE
    PMA / PMN Number
    P070008
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    OR, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    THIS LEAD DISLODGED AND WAS SUCCESSFULLY REPOSITIONED. ALL RECORDS INDICATE THIS LEAD REMAINS ACTIVELY IMPLANTED. SHOULD ADDITIONAL INFO BECOME AVAILABLE, THIS EVENT WILL BE UPDATED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 COROX OTW-S 75-BP LV LEAD NKE BIOTRONIK SE & CO KG 355148

    Patients

    Seq Age Sex Outcome Treatment
    1 65 YR Hospitalization