BEUDAMED
    FDA Adverse Event Death Summary report: N

    QUICK FLEX LV LEAD

    MDR report key: 2072255 · Received April 28, 2011

    Report

    Report Number
    2017865-2011-02494
    Event Type
    Death
    Date Received
    April 28, 2011
    Date of Event
    February 17, 2011
    Manufacturer
    ST JUDE MEDICAL CARDIAC RHYTHM MANAGEMENT DIVISION
    Product Code
    OJX
    PMA / PMN Number
    P030054
    Removal / Correction Number
    NA
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    NJ
    Reporter Occupation
    OTHER HEALTH CARE PROFESSIONAL

    Narratives

    Additional Manufacturer Narrative · 1

    ALL INFORMATION PROVIDED BY MANUFACTURER, NO MEDWATCH FORM WAS RECEIVED.

    Description of Event or Problem · 1

    IT WAS REPORTED THAT THE PATIENT EXPIRED ON 02/17/2011. THERE IS NO ALLEGATION FROM A HEALTH CARE PROFESSIONAL THAT THE DEATH WAS DEVICE RELATED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 QUICK FLEX LV LEAD PERMANENT PACEMAKER ELECTRODE OJX ST JUDE MEDICAL CARDIAC RHYTHM MANAGEMENT DIVISION 1156T/86 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 84 YR Death 3207-36, 547770, 7120, AHA31401, 1699TC, EP033569