BEUDAMED
    FDA Adverse Event Death Summary report: N

    QUICKFLEX XL LV LEAD

    MDR report key: 2842457 · Received November 21, 2012

    Report

    Report Number
    2017865-2012-10485
    Event Type
    Death
    Date Received
    November 21, 2012
    Date of Event
    June 4, 2009
    Manufacturer
    ST JUDE MEDICAL CARDIAC RHYTHM MANAGEMENT DIVISION
    Product Code
    NIK
    PMA / PMN Number
    P030054
    Removal / Correction Number
    Z1483
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    LA
    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 HAD DECEASED. THERE IS NO ALLEGATION FROM A HEALTH CARE PROFESSIONAL SUGGESTING THAT THE DEATH WAS DEVICE RELATED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 QUICKFLEX XL LV LEAD PERMANENT PACEMAKER ELECTRODE NIK ST JUDE MEDICAL CARDIAC RHYTHM MANAGEMENT DIVISION 1158T/86 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 70 YR Death 3207, (B)(4),7071, (B)(4),1882, (B)(4)