BEUDAMED
    FDA Adverse Event Death Summary report: N

    NEEDLE'S EYE SNARE

    MDR report key: 510426 · Received February 5, 2004

    Report

    Report Number
    2522007-2004-00001
    Event Type
    Death
    Date Received
    February 5, 2004
    Date of Event
    January 2, 2004
    Report Date
    January 7, 2004
    Manufacturer
    COOK VASCULAR INC.
    Product Code
    MFA
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    DA
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    THE DOCTOR TRIED SEVERAL TIMES TO GRASP/WITHDRAW THE LINE, WHICH RESULTED IN AN EMBOLUS IN THE LEFT VENTRICLE AND THE PATIENT DIED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 NEEDLE'S EYE SNARE CATHETER RETRIEVAL DEVICE MFA COOK VASCULAR INC. LR-NES002 35772

    Patients

    Seq Age Sex Outcome Treatment
    1 42 YR Death