BEUDAMED
    FDA Adverse Event Death Summary report: N

    UNKNOWN

    MDR report key: 2192974 · Received March 6, 2008

    Report

    Report Number
    2192974
    Event Type
    Death
    Date Received
    March 6, 2008
    Date of Event
    June 23, 2007
    Report Date
    March 3, 2008
    Manufacturer
    UNKNOWN
    Product Code
    LTI
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    CA, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    PATIENT DEVELOPED AN ACUTE ABDOMEN ON (B)(6) 2007, FOUND TO HAVE A PERFORATION OF THE STOMACH AT THE SITE OF HIS GASTRIC BAND. HE UNDERWENT EMERGENCY SURGERY AND RECEIVED AN OMENTAL PATCH. HE EXPIRED ON (B)(6) 2007 OF SEPTIC SHOCK AND MULTIORGAN FAILURE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 UNKNOWN UNKNOWN GASTRIC BAND LTI UNKNOWN

    Patients

    Seq Age Sex Outcome Treatment
    1 72 YR Death