BEUDAMED
    FDA Adverse Event Death Summary report: N

    PULSE GEN MODEL 1000

    MDR report key: 15784092 · Received November 11, 2022

    Report

    Report Number
    1644487-2022-01434
    Event Type
    Death
    Date Received
    November 11, 2022
    Date of Event
    October 13, 2022
    Report Date
    November 11, 2022
    Manufacturer
    CYBERONICS - HOUSTON
    Product Code
    LYJ
    UDI-DI
    05425025750405
    PMA / PMN Number
    P970003
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    OK, US
    Reporter Occupation
    PHYSICIAN
    Health Professional
    Yes

    Narratives

    Additional Manufacturer Narrative · 0

    LIVANOVA USA, INC. SUBMITS THIS REPORT TO COMPLY WITH 21 C.F.R. PART 803, THE MEDICAL DEVICE REPORTING REGULATION, BASED ON INFORMATION THAT LIVANOVA HAS OBTAINED, BUT MAY NOT HAVE BEEN ABLE TO INVESTIGATE OR VERIFY PRIOR TO THE DATE THE REPORT WAS REQUIRED BY THE FDA. THIS REPORT DOES NOT CONSTITUTE AN ADMISSION, OR A CONCLUSION BY FDA OR ANYONE ELSE, THAT THE DEVICE, LIVANOVA, OR LIVANOVA'S EMPLOYEES CAUSED OR CONTRIBUTED TO THE EVENT DESCRIBED IN THE REPORT. IN PARTICULAR, THIS REPORT DOES NOT CONSTITUTE AN ADMISSION BY ANYONE THAT THE PRODUCT DESCRIBED IN THIS REPORT HAS ANY "DEFECTS¿ OR "MALFUNCTIONS¿. THESE WORDS ARE INCORPORATED INTO THE FDA 3500A MEDWATCH FORM BY THE FDA, AND LIVANOVA OBJECTS TO THEIR USE.

    Description of Event or Problem · 0

    IT WAS NOTED THAT PATIENT HAD DIED ON DUE TO AN UNKNOWN REASON. CHIEF MEDICAL EXAMINER REQUESTED THE PATIENT'S VNS TO BE INTERROGATED TO ASSIST THE MEDICAL EXAMINER IN DETERMINING THE CAUSE OF DEATH FOR A PATIENT. THE PHYSICIAN STATES THE BODY WAS BADLY DECOMPOSED & CAUSE OF DEATH IS UNDETERMINED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    2780111 PULSE GEN MODEL 1000 GENERATOR LYJ CYBERONICS - HOUSTON 1000 204563 05425025750405

    Patients

    Seq Age Sex Outcome Treatment
    1 63 YR Male Death