BEUDAMED
    FDA Adverse Event Death Summary report: N

    VENA CAVA FILTER

    MDR report key: 21670 · Received April 6, 1995

    Report

    Report Number
    21670
    Event Type
    Death
    Date Received
    April 6, 1995
    Date of Event
    March 28, 1995
    Report Date
    March 28, 1995
    Manufacturer
    MEDITECH, INC.
    Product Code
    DTK
    Adverse Event
    Yes
    Report Source
    User Facility report
    Reporter Location
    NJ, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    SP ADMISSION FOR PULMONARY EMBOLISM. PT WENT TO THE OR FOR INSERTION OF AN INTRAVASCULAR FILTER. FIVE HOURS POST-OP PT BECAME PULSELESS AND APNEECI. RESUSCITATIVE EFFORTS UNSUCCESSFUL.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 VENA CAVA FILTER Implant JUGULAR FILTER DTK MEDITECH, INC.

    Patients

    Seq Age Sex Outcome Treatment
    1 68 YR Death