BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    MEDTRONIC INC.

    MDR report key: 633894 · Received September 1, 2005

    Report

    Report Number
    633894
    Event Type
    Malfunction
    Date Received
    September 1, 2005
    Date of Event
    July 15, 2005
    Manufacturer
    *
    Product Code
    ---
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    HI, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    MALFUNCTIONING PACEMAKER.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 MEDTRONIC INC. PACEMAKER-ICD/IPG, LEADS & ADAPTERS --- * 7274 NA
    2 MEDTRONIC INC. PACEMAKER-ICD/IPG, LEADS & ADAPTERS --- * 6947-65 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 59 YR