BEUDAMED
    FDA Adverse Event Death Summary report: N

    TEMPORARY PACING WIRE

    MDR report key: 545516 · Received September 22, 2004

    Report

    Report Number
    2210968-2004-00465
    Event Type
    Death
    Date Received
    September 22, 2004
    Date of Event
    December 22, 2003
    Report Date
    August 23, 2004
    Manufacturer
    ETHICON, INC.
    Product Code
    GAQ
    Removal / Correction Number
    NA
    Report Source
    Manufacturer report
    Reporter Occupation
    RISK MANAGER

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 TEMPORARY PACING WIRE SUTURE, NON-ABSORBABLE GAQ ETHICON, INC. * UNK

    Patients

    Seq Age Sex Outcome Treatment
    1 78 YR Death