BEUDAMED
    FDA Adverse Event Death Summary report: N

    DLP PERFUSION ADAPTOR

    MDR report key: 1634848 · Received March 16, 2010

    Report

    Report Number
    1634848
    Event Type
    Death
    Date Received
    March 16, 2010
    Date of Event
    December 24, 2009
    Report Date
    March 16, 2010
    Manufacturer
    MEDTRONIC
    Product Code
    DTL
    Adverse Event
    Yes
    Report Source
    User Facility report
    Reporter Location
    IL, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    WHILE MOVING PATIENT FOR BASIC NURSING CARE, ADAPTOR SNAPPED. PATIENT STARTED TO BLEED FROM CATHETERS AS A RESULT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 DLP PERFUSION ADAPTOR ADAPTOR, CARDIOPULMONARY BYPASS DTL MEDTRONIC * UNK

    Patients

    Seq Age Sex Outcome Treatment
    1 39 YR Death CARDIAC DRUGS| LONG-TERM ANTIBIOTICS