BEUDAMED
    FDA Adverse Event Injury Summary report: N

    SJM MECHANICAL HEART VALVE

    MDR report key: 1940663 · Received December 22, 2010

    Report

    Report Number
    2648612-2010-00080
    Event Type
    Injury
    Date Received
    December 22, 2010
    Date of Event
    November 19, 2010
    Report Date
    December 22, 2010
    Manufacturer
    ST. JUDE MEDICAL, PUERTO RICO, INC (CS)
    Product Code
    LWQ
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    KY, US
    Reporter Occupation
    PATIENT

    Narratives

    Description of Event or Problem · 1

    IT WAS REPORTED BY THE PT THAT THIS VALVE WAS EXPLANTED 21 YEARS POSTOPERATIVELY. HE WANTED TO SEND THE VALVE BACK TO SJM AND DID NOT HAVE A COMPLAINT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 SJM MECHANICAL HEART VALVE STANDARD HEART VALVE LWQ ST. JUDE MEDICAL, PUERTO RICO, INC (CS) 23A-101

    Patients

    Seq Age Sex Outcome Treatment
    1 46 YR Hospitalization| R