BEUDAMED
    FDA Adverse Event Injury Summary report: N

    MEDTRONIC

    MDR report key: 421764 · Received October 14, 2002

    Report

    Report Number
    421764
    Event Type
    Injury
    Date Received
    October 14, 2002
    Date of Event
    October 14, 2002
    Report Date
    October 14, 2002
    Manufacturer
    MEDTRONIC INC
    Product Code
    DTB
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    NY, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    DROP IN BIPOLAR "IMEPENCE" ON LEAD. 09/1999 897 OHMS, 10/2000 745 OHMS, 10/2001 711 OHMS, 04/2002 515 OHMS, 2002 386 OHMS.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 MEDTRONIC VENTRICULAR PACING LEAD DTB MEDTRONIC INC 4024 *

    Patients

    Seq Age Sex Outcome Treatment
    1 75 YR Hospitalization| R