BEUDAMED
    FDA Adverse Event Injury Summary report: N

    GEMIII AT

    MDR report key: 2803276 · Received July 7, 2008

    Report

    Report Number
    2803276
    Event Type
    Injury
    Date Received
    July 7, 2008
    Date of Event
    May 6, 2008
    Report Date
    July 2, 2008
    Manufacturer
    MEDTRONIC, INC.
    Product Code
    ---
    Adverse Event
    Yes
    Report Source
    User Facility report
    Reporter Location
    HI, US
    Reporter Occupation
    OTHER HEALTH CARE PROFESSIONAL

    Narratives

    Description of Event or Problem · 1

    END OF LIFE/ LEAD MALFUNCTION.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 GEMIII AT GENERATOR --- MEDTRONIC, INC. 7276
    2 VENTILATOR LEAD LEAD --- MEDTRONIC INC. 5568-53

    Patients

    Seq Age Sex Outcome Treatment
    1 75 YR Hospitalization