BEUDAMED
    FDA Adverse Event Injury Summary report: N

    CYPHER STENT

    MDR report key: 498909 · Received November 18, 2003

    Report

    Report Number
    MW1030324
    Event Type
    Injury
    Date Received
    November 18, 2003
    Date of Event
    October 5, 2003
    Report Date
    November 15, 2003
    Manufacturer
    J & J
    Product Code
    NIQ
    Adverse Event
    Yes
    Report Source
    Voluntary report
    Reporter Location
    OR, US
    Reporter Occupation
    PHYSICIAN

    Narratives

    Description of Event or Problem · 1

    SUBACUTE THROMBOSIS 48HR AFTER PLACEMENT OF A CYPHER STENT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 CYPHER STENT * NIQ J & J * 40803836

    Patients

    Seq Age Sex Outcome Treatment
    1 62 YR Hospitalization| L| R