European Pacemaker Patient Identification card

 

 

1. Patient-Data

Patientnr  6601669

Identification nr        BAA010922

Name                       Baart-v.Eede J.P.

 

Address 1               Pr. Mariannelaan 15

City                          2275 BA Voorburg

Country                   Netherlands

Telephone nr           +31 (0)703860843 

 

Address 2               Plza Granada 2

                                Pueblo Mascarat

City                          Altea 03590

Country                   Spain

Telephone nr           +34 (0)965841450

 

Mobile phone           +31 (0)629275302

 

Date of birth            01-sept-1922          Female

 

1e implantation        19-apr-2002

Symptom B2    ECG E5    Aetiology B1

Pacemaker dependent: No

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2. Pacemaker centre               16

Doctor                     Dr. Stassen

Hospital                   Reinier de Graaf Gasthuis

Address                  Reinier de Graafweg 3 - 11

Postcode                 2625 AD Delft

Country                   Holland

Telephone nr           +31 (0)152603060

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3. Pacemaker

Mfg          Vitatron

Type        9000        Serial nr 0216216743

Date of implantation 19-apr-2002

Mode       DDDR                       Rate  65 ppm

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4. Leads

Atrial lead

Mfg          Vitatron                   IS1: yes

Type        ICF09                       Serialnr VMR015468V

Date of impl. 19-apr-2002   Uni.: no    Bi.: yes

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Vetricular lead

Mfg          Vitatron                   IS1: yes

Type        IMK49B                    Serialnr PJA014054V

Date of impl. 19-apr-2002   Uni.: no    Bi.: yes

 

 

 

 

 

General Practitioner

Name                       Willemse P.G.

 

Cardiologist

Name                       Poli Cardiologie

Address                  Reinier de Graafweg 3 - 11

City                         2625 AD Delft

Country                   Netherlands

Telephone nr           +31 (0)152603060

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                                Atrial:                       Ventricular

Threshold                1,3 V                       0,6 V

Current                    2,8 mA                     0,9 mA

Resistance              440 Ohm  695 Ohm

I ecg                        1,6 mV                     12 mV

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ERT                          MR=86 ppm

Warrenty 5 years

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Patient file

Friday, 19 April 2002

 

 

 

 

 

 

 

 

 

THROMBOSIS CARD

Stichting Rode Kruis Trombosedienst

's-Gravenhage en Omstreken

 

Karel Doormanlaan 155

2283 AL Rijswijk

Tel.:         +31(0)70 372 0372

Fax.:        +31(0)70 394 2077

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Name:                     

                J.P. Baart-van Eede

Patientnr:

                0530368

Gebruikt het antistollingsmiddel:

                FENPROCOUMON  MARCOUMAR