BEUDAMED
    FDA Adverse Event Death Summary report: N

    SPRINT QUATTRO SECURE

    MDR report key: 2171969 · Received July 22, 2011

    Report

    Report Number
    2649622-2011-10863
    Event Type
    Death
    Date Received
    July 22, 2011
    Date of Event
    June 20, 2011
    Manufacturer
    MEDTRONIC PUERTO RICO, INC.
    Product Code
    LWS
    PMA / PMN Number
    P920015/S24
    Removal / Correction Number
    Z-0475-2011
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    IN, US
    Reporter Occupation
    PHYSICIAN

    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.

    Description of Event or Problem · 1

    IT WAS REPORTED THAT THE PATIENT DEVELOPED SLOW VENTRICULAR TACHYCARDIA WHICH WAS IN AND OUT OF THE DETECTION ZONE. THE DEVICE DID NOT DETECT THE ARRHYTHMIA AND THERAPY WAS DELAYED. THE PATIENT EXPIRED DUE TO CARDIAC ARREST. FURTHER DETAILS SURROUNDING THE DEATH HAVE BEEN REQUESTED AND NOT RECIEVED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 SPRINT QUATTRO SECURE IMPLANTABLE TACHY LEAD LWS MEDTRONIC PUERTO RICO, INC. 6947 ASKU

    Patients

    Seq Age Sex Outcome Treatment
    1 71 YR Death| O