BEUDAMED
    FDA Adverse Event Other Summary report: N

    MEDTRONIC

    MDR report key: 838087 · Received April 11, 2007

    Report

    Report Number
    MW1042567
    Event Type
    Other
    Date Received
    April 11, 2007
    Date of Event
    March 21, 2007
    Report Date
    March 29, 2007
    Manufacturer
    MEDTRONIC
    Product Code
    LWS
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    MA, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    LEAD FIRED AND PT WAS SHOCKED THREE TIMES INAPPROPRIATELY. LEAD TAKEN OUT AND REPLACED, NO HARM TO PT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 MEDTRONIC DEFIBRILLATOR LEAD LWS MEDTRONIC DF-1A SVC (18CM) *

    Patients

    Seq Age Sex Outcome Treatment
    1 40 YR Other