BEUDAMED
    FDA Adverse Event Death Summary report: N

    OLYMPUS

    MDR report key: 227933 · Received May 25, 1999

    Report

    Report Number
    227933
    Event Type
    Death
    Date Received
    May 25, 1999
    Date of Event
    May 17, 1999
    Report Date
    May 21, 1999
    Manufacturer
    OLYMPUS / OLYMPUS AMERICA INC. ENDOSCOPE DIVISION
    Product Code
    FDF
    Adverse Event
    Yes
    Report Source
    User Facility report
    Reporter Location
    TX, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    PATIENT UNDERWENT A COLONOSCOPY 5/17/99, START TIME 1316; STOP TIME 1334. 1340 PATIENT C/O SEVERE ABDOMINAL PAIN. 2 ABDOMINAL X-RAY'S DONE WHICH SHOWED PERFORATED ABDOMINAL VISCUS. PT. DECOMPENSATED RAPIDLY, WAS TRANSFERRED TO SICU: STAT SURGICAL CONSULT OBTAINED, BEFORE PT. COULD BE TAKEN TO OR: CODED, EXPIRED, PRONOUNCED DEAD AT 1618.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 OLYMPUS COLONOSCOPE FDF OLYMPUS / OLYMPUS AMERICA INC. ENDOSCOPE DIVISION CF 1401 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 64 YR Death