BEUDAMED
    FDA Adverse Event Death Summary report: N

    INTRINSIC

    MDR report key: 2021786 · Received March 17, 2011

    Report

    Report Number
    6000144-2011-01069
    Event Type
    Death
    Date Received
    March 17, 2011
    Date of Event
    October 17, 2005
    Manufacturer
    MEDTRONIC MED REL, INC.
    Product Code
    LWS
    PMA / PMN Number
    P980016/S041
    Removal / Correction Number
    ASKU
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    IL, US
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 1

    THE INFORMATION SUBMITTED REFLECTS ALL RELEVANT DATA RECEIVED. IF ADDITIONAL RELEVANT INFORMATION IS RECEIVED, A SUPPLEMENTAL REPORT WILL BE SUBMITTED. ALL INFORMATION KNOWN WAS PROVIDED PER THE COMPLAINANT. THEREFORE, NO ATTEMPTS FOR ADDITIONAL INFORMATION WILL BE MADE. THE LEAD MODEL 6949 IS PART OF THE ADVISORY.

    Description of Event or Problem · 1

    AN ALLEGATION FROM AN ATTORNEY INDICATED THE PATIENT DIED APPROXIMATELY TWO MONTHS POST IMPLANT OF THE RIGHT VENTRICULAR LEAD. FURTHER REVIEW REVEALED THAT PATIENT DIED APPROXIMATELY TWO MONTHS POST IMPLANT OF THE IMPLANTABLE CARDIOVERTER DEFIBRILLATOR AND RIGHT ATRIAL LEAD AS WELL. IT WAS ALSO NOTED THE PATIENT SUFFERED EXTREME PHYSICAL INJURY AND "[D]EATH ASSOCIATED WITH EXPLANT."

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 INTRINSIC IMPLANTABLE PACEMAKER/CARDIO/DEFIB LWS MEDTRONIC MED REL, INC. 7288 ASKU

    Patients

    Seq Age Sex Outcome Treatment
    1 63 YR Death