BEUDAMED
    FDA Adverse Event Death Summary report: N

    SURGIPRO II 6/0 24 BLUE KV-11 D/A

    MDR report key: 3170049 · Received June 4, 2013

    Report

    Report Number
    1219930-2013-00417
    Event Type
    Death
    Date Received
    June 4, 2013
    Date of Event
    March 17, 2006
    Report Date
    May 6, 2013
    Manufacturer
    COVIDIEN, FORMERLY US
    Product Code
    GAW
    PMA / PMN Number
    K010909
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    IT
    Reporter Occupation
    ATTORNEY

    Narratives

    Additional Manufacturer Narrative · 1

    (B)(4).

    Description of Event or Problem · 1

    ON (B)(6) 2006 A RIGHT CAROTID ENDARTERECTOMY WAS PERFORMED DEHISCENCE OF THE THREAD WHICH CAUSED A BLEEDING ACUTE, THE PATIENT DIED ON (B)(6) 2006.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    247477 SURGIPRO II 6/0 24 BLUE KV-11 D/A SURGIPRO SUTURE GAW COVIDIEN, FORMERLY US

    Patients

    Seq Age Sex Outcome Treatment
    1 71 YR Death