BEUDAMED
    FDA Adverse Event Death Summary report: N

    MEDTRONIC

    MDR report key: 370926 · Received January 3, 2002

    Report

    Report Number
    370926
    Event Type
    Death
    Date Received
    January 3, 2002
    Date of Event
    May 17, 2001
    Report Date
    June 19, 2001
    Manufacturer
    MEDTRONIC, INC
    Product Code
    DXY
    Adverse Event
    Yes
    Report Source
    User Facility report
    Reporter Location
    OH, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    PT WAS UNDERGOING INSERTION OF PERMANENT PACEMAKER AND DEVELOPED CARDIAC TAMPONADE/MI.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 MEDTRONIC PACEMAKER DXY MEDTRONIC, INC SDR303 *
    2 MEDTRONIC PACEMAKER DTB MEDTRONIC, INC 5076 45 *
    3 MEDTRONIC PACEMAKER DTB MEDTRONIC, INC 5068-52 *

    Patients

    Seq Age Sex Outcome Treatment
    1 91 YR Death| L