BEUDAMED
    FDA Adverse Event Death Summary report: N

    FUKUDA DENSHI MODEL LX-3100

    MDR report key: 290972 · Received August 14, 2000

    Report

    Report Number
    9611031-2000-00003
    Event Type
    Death
    Date Received
    August 14, 2000
    Date of Event
    May 27, 2000
    Report Date
    August 11, 2000
    Manufacturer
    FUKUDA DENSHI CO., LTD.
    Product Code
    DSI
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    KY, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    ON 07/10/2000, THE HOSP FORWARDED A COPY OF MEDWATCH FORM. THE DESCRIPTION ON FORM WAS "PT ON TELEMETRY FOUND PULSELESS WITH NO RESPIRATION. POSSIBLE MISSED CONNECTION BETWEEN TERMINAL BOX AND CABLE."

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 FUKUDA DENSHI MODEL LX-3100 TELEMETRY TRANSMITTER DSI FUKUDA DENSHI CO., LTD. LX-3100 *

    Patients

    Seq Age Sex Outcome Treatment
    1 67 YR Death