FDA Adverse Event Death Summary report: N

HELI-FX ENDOANCHOR SYSTEM

MDR report key: 4990269 · Received August 4, 2015

Report

Report Number
3008493192-2015-00013
Event Type
Death
Date Received
August 4, 2015
Report Date
June 30, 2015
Manufacturer
MEDTRONIC VASCULAR, INC.
Product Code
OTD
PMA / PMN Number
DEN100026
Adverse Event
Yes
Report Source
Manufacturer report
Reporter Location
UK
Reporter Occupation
1

Narratives

Description of Event or Problem · 1

MEDTRONIC VASCULAR BECAME AWARE OF A PATIENT ADVERSE OUTCOME FROM A PHYSICIAN PRESENTATION ON ENDOANCHORING RESULTS IN THE (B)(6). THE PHYSICIAN PRESENTER WAS NOT THE OPERATING PHYSICIAN FOR THE PROCEDURE BEING REPORTED. PER THE PRESENTATION, A PATIENT WHO WAS TREATED WITH HELI-FX ENDOANCHORS EXPERIENCED A PERFORATED AND ISCHEMIC BOWEL AND AN OCCLUDED ENDOGRAFT, AND EXPIRED. THE ENDOANCHORING PROCEDURE AND EVENT DATES ARE UNKNOWN AND IT IS NOT KNOWN IF THE PATIENT ADVERSE EVENTS AND OUTCOME WERE A RESULT OF THE ENDOANCHORS OR ENDOANCHORING PROCEDURE. IT IS ALSO UNKNOWN WHEN THE PATIENT ADVERSE EVENTS OCCURRED RELATIVE TO THE ENDOANCHORING PROCEDURE. MULTIPLE ATTEMPTS TO OBTAIN ADDITIONAL INFORMATION FROM THE IMPLANTING PHYSICIAN WERE UNSUCCESSFUL. THEREFORE, THE RELATEDNESS OF THE ENDOANCHORING PROCEDURE TO THE PATIENT'S COMPLICATIONS AND ULTIMATE DEATH CANNOT BE POSITIVELY CONFIRMED OR REFUTED.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
511626 HELI-FX ENDOANCHOR SYSTEM ENDOVASCULAR SUTURING SYSTEM OTD MEDTRONIC VASCULAR, INC.

Patients

Seq Age Sex Outcome Treatment
1 Death