FDA Adverse Event
Death
Summary report: N
EDWARDS PERICARDIAL PATCH
MDR report key: 1661945
·
Received April 19, 2010
Report
- Report Number
- 2015691-2010-13155
- Event Type
- Death
- Date Received
- April 19, 2010
- Date of Event
- February 26, 2010
- Report Date
- March 22, 2010
- Manufacturer
- EDWARDS LIFESCIENCES
- Product Code
- DXZ
- PMA / PMN Number
- K833763
- Adverse Event
- Yes
- Report Source
- Manufacturer report
- Reporter Location
- IN, US
- Reporter Occupation
- PHYSICIAN
Narratives
Additional Manufacturer Narrative · 1
DEVICE NOT RETURNED. THIS EVENT WAS DETERMINED TO BE REPORTABLE PER EDWARDS LIFESCIENCES PROCEDURES. THE INFORMATION WAS LEARNED THROUGH IMPLANT PATIENT REGISTRY. THE DEVICE HISTORY RECORD (DHR) REVIEW WAS COMPLETED, AND THERE WERE NO NONCONFORMANCE FOUND RELATED TO THIS EVENT. TWO REQUESTS WERE MADE TO THE HEALTH-CARE PROVIDER (VIA FAX) FOR THE DEVICE, OPERATIVE REPORT, AND ADDITIONAL INFORMATION; HOWEVER, NO RESPONSE HAS BEEN RECEIVED. THE CAUSE OF DEATH REMAINS UNKNOWN.
Description of Event or Problem · 1
IT WAS REPORTED THAT THE PATIENT HAS EXPIRED AFTER AN IMPLANT DURATION OF APPROXIMATELY 0.1 MONTHS, DUE TO UNKNOWN REASONS. IT IS UNKNOWN IF THE DEATH WAS DEVICE RELATED. NO FURTHER DETAILS WERE PROVIDED.
Devices
| Seq | Brand | Generic | Product Code | Manufacturer | Model | Lot | UDI-DI |
|---|---|---|---|---|---|---|---|
| 1 | EDWARDS PERICARDIAL PATCH | PERICARDIAL PATCH | DXZ | EDWARDS LIFESCIENCES | 4700 | R-09J2259 |
Patients
| Seq | Age | Sex | Outcome | Treatment |
|---|---|---|---|---|
| 1 | 70 YR | Death |