BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    HI-PER COAT DIRECT WIRE 300ST

    MDR report key: 504365 · Received December 15, 2003

    Report

    Report Number
    1220452-2003-00166
    Event Type
    Malfunction
    Date Received
    December 15, 2003
    Date of Event
    November 20, 2003
    Report Date
    November 25, 2003
    Manufacturer
    MEDTRONIC, INC.
    Product Code
    DQT
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CA, US
    Reporter Occupation
    OTHER

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 HI-PER COAT DIRECT WIRE 300ST PTCA WIRES DQT MEDTRONIC, INC. NA 147889

    Patients

    Seq Age Sex Outcome Treatment
    1 UNKNOWN