BEUDAMED
    FDA Adverse Event Death Summary report: N

    QUARTET

    MDR report key: 3232473 · Received July 18, 2013

    Report

    Report Number
    2017865-2013-04957
    Event Type
    Death
    Date Received
    July 18, 2013
    Date of Event
    May 31, 2013
    Manufacturer
    ST JUDE MEDICAL CARDIAC RHYTHM MANAGEMENT DIVISION
    Product Code
    DTB
    PMA / PMN Number
    NA
    Removal / Correction Number
    NA
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    NJ
    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 HAS DECEASED. THERE IS NO ALLEGATION FROM A HEALTHCARE PROFESSIONAL THAT SUGGESTS THAT THE DEATH WAS DEVICE RELATED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    333211 QUARTET PERMANENT PACEMAKER ELECTRODE DTB ST JUDE MEDICAL CARDIAC RHYTHM MANAGEMENT DIVISION 1458Q/86 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 82 YR Death MEDTRONIC: 6935,TDL019262V, 2088TC/52,CAU122114