BEUDAMED
    FDA Adverse Event Death Summary report: N

    ASKU

    MDR report key: 1902641 · Received November 18, 2010

    Report

    Report Number
    2183613-2010-00302
    Event Type
    Death
    Date Received
    November 18, 2010
    Manufacturer
    MEDTRONIC MILACA INC.
    Product Code
    DTE
    PMA / PMN Number
    P820003/S72
    Removal / Correction Number
    ASKU
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    MI, US
    Reporter Occupation
    PHYSICIAN

    Narratives

    Additional Manufacturer Narrative · 1

    THIS IS 10 OF 14 EVENTS THAT OCCURRED AT THIS USER FACILITY IDENTIFIED IN MEDWATCH. THE INFORMATION SUBMITTED REFLECTS ALL RELEVANT DATA RECEIVED. IF ADDITIONAL RELEVANT INFORMATION IS RECEIVED, A SUPPLEMENTAL REPORT WILL BE SUBMITTED.

    Additional Manufacturer Narrative · 1

    THIS IS 10 OF 14 EVENTS THAT OCCURRED AT THIS USER FACILITY. THE INFORMATION SUBMITTED REFLECTS ALL RELEVANT DATA RECEIVED. IF ADDITIONAL RELEVANT INFORMATION IS RECEIVED, A SUPPLEMENTAL REPORT WILL BE SUBMITTED. EVALUATION SUMMARY: (B)(4) ANALYSIS COULD NOT CONFIRM THE REPORTED EVENT. THE EPG (EXTERNAL PULSE GENERATOR) PASSED TESTING, WITH NO ANOMALIES FOUND. THE BATTERY CONTACTS WERE NOTED TO BE COMPRESSED, AND THE LEAD FLEX COVER, BATTERY DRAWER, AND BATTERY FLEX WERE CONTAMINATED. THE UPPER CASE WAS DENTED, AND THE KEYBOARD WAS DAMAGED DUE TO THE UPPER CASE DENT AND WAS PUSHED ON THE EDGE OF THE KEYBOARD. THE LOWER CASE, SIDE BAIL COVERS, AND RING COVER WERE ALSO BROKEN, AND THE RING WAS MISSING.

    Description of Event or Problem · 1

    A CALL TO TECHNICAL SERVICES FROM THE BIOMEDICAL DEPARTMENT REPRESENTATIVE REPORTED THE PHYSICIAN BELIEVES THE EXTERNAL PULSE GENERATORS (EPG) MAY BE INDUCING VENTRICULAR FIBRILLATION, AND TWO DEATHS HAVE BEEN NOTED. THE SERIAL NUMBER OF THE EPG CONNECTED TO PATIENTS AT THE TIME OF THESE UNTOWARD EVENTS IS UNKNOWN. THE CALLER FURTHER REPORTED DEPARTMENT QUARTERLY CHECKS WERE COMPLETED AND FOUND NO ISSUES WITH THE EXTERNAL GENERATORS.

    Description of Event or Problem · 1

    A CALL TO TECHNICAL SERVICES FROM THE BIOMEDICAL DEPARTMENT REPRESENTATIVE REPORTED THE PHYSICIAN BELIEVED THE EXTERNAL PULSE GENERATORS (EPG'S) MAY HAVE BEEN INDUCING VENTRICULAR FIBRILLATION, AND TWO DEATHS HAVE BEEN NOTED. THE SERIAL NUMBER OF THE EPG CONNECTED TO PATIENTS AT THE TIME OF THESE UNTOWARD EVENTS IS UNKNOWN. THE CALLER FURTHER REPORTED THAT DEPARTMENT QUARTERLY CHECKS WERE COMPLETED AND FOUND NO ISSUES WITH THE EXTERNAL PULSE GENERATORS.

    Description of Event or Problem · 1

    A CALL TO TECHNICAL SERVICES FROM THE BIOMEDICAL DEPARTMENT REPRESENTATIVE REPORTED THE PHYSICIAN BELIEVED THE EXTERNAL PULSE GENERATORS (EPG'S) MAY HAVE BEEN INDUCING VENTRICULAR FIBRILLATION, AND TWO DEATHS HAVE BEEN NOTED. THE SERIAL NUMBER OF THE EPG CONNECTED TO PATIENTS AT THE TIME OF THESE UNTOWARD EVENTS IS UNKNOWN. THE CALLER FURTHER REPORTED THAT DEPARTMENT QUARTERLY CHECKS WERE COMPLETED AND FOUND NO ISSUES WITH THE EXTERNAL PULSE GENERATORS.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ASKU EXTERNAL PULSE GENERATOR DTE MEDTRONIC MILACA INC. 5388 ASKU

    Patients

    Seq Age Sex Outcome Treatment
    1 Death| H| R