BEUDAMED
    FDA Adverse Event Death Summary report: N

    CORDIS

    MDR report key: 1844075 · Received September 22, 2010

    Report

    Report Number
    1844075
    Event Type
    Death
    Date Received
    September 22, 2010
    Date of Event
    September 10, 2010
    Report Date
    September 17, 2010
    Manufacturer
    CORDIS CORP
    Product Code
    DTK
    Adverse Event
    Yes
    Report Source
    User Facility report
    Reporter Location
    KS, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    PRE-OP X-RAY ON (B)(6) 2010, SHOWED VENA CAVA FILTER HAD MIGRATED INTO THE RIGHT ATRIUM. THE PROCEDURE TO REMOVE THE FILTER WAS SUCCESSFUL, HOWEVER, THE PT COMPLAINED OF CHEST PAIN AND SHORTNESS OF BREATH IMMEDIATELY UPON REMOVAL. A STAT ECHOCARDIOGRAM SHOWED RIGHT ATRIAL COLLAPSE AND PT STATUS DECLINED RAPIDLY LEADING TO A CODE BLUE, IMMEDIATE TRANSFER TO OPERATING ROOM FOR ATRIAL REPAIR. PT DIED TWO DAYS FOLLOWING.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 CORDIS TRAPEASE IVC FILTER DTK CORDIS CORP UNK

    Patients

    Seq Age Sex Outcome Treatment
    1 60 YR Death