BEUDAMED
    FDA Adverse Event Injury Summary report: N

    MEDTRONIC, INC

    MDR report key: 507167 · Received January 15, 2004

    Report

    Report Number
    507167
    Event Type
    Injury
    Date Received
    January 15, 2004
    Date of Event
    October 22, 2003
    Report Date
    December 19, 2003
    Manufacturer
    MEDTRONIC, INC.
    Product Code
    LWS
    Adverse Event
    Yes
    Report Source
    User Facility report
    Reporter Location
    MO, US
    Reporter Occupation
    PHYSICIAN

    Narratives

    Description of Event or Problem · 1

    PACEMAKER DID NOT DISPLAY TELEMETRY AFTER FOUR PROGRAMMER ATTEMPTS TO FIX.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 MEDTRONIC, INC ICD LWS MEDTRONIC, INC. 7227CX 270CT03

    Patients

    Seq Age Sex Outcome Treatment
    1 77 YR Required Intervention