BEUDAMED
    FDA Adverse Event Injury Summary report: N

    CAPSURE SP

    MDR report key: 255250 · Received July 26, 1999

    Report

    Report Number
    2649622-1999-00318
    Event Type
    Injury
    Date Received
    July 26, 1999
    Date of Event
    May 12, 1999
    Manufacturer
    MEDTRONIC PUERTO RICO, INC.
    Product Code
    DTB
    Removal / Correction Number
    NI
    Report Source
    Manufacturer report
    Reporter Location
    FL, US
    Reporter Occupation
    MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE

    Narratives

    Description of Event or Problem · 1

    LOSS OF V SENSING, PROGRAMMED TO UNIPOLAR, STILL IN USE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 CAPSURE SP Implant IMPLANTABLE PACING LEAD DTB MEDTRONIC PUERTO RICO, INC. 4024 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 92 YR Other 4524 IMPLANTABLE PACING LEAD| 7074 IMPLANTABLE PULSE GENERATOR