BEUDAMED
    FDA Adverse Event Death Summary report: N

    J & J CORDIS

    MDR report key: 547962 · Received July 1, 2004

    Report

    Report Number
    MW1032511
    Event Type
    Death
    Date Received
    July 1, 2004
    Date of Event
    April 12, 2004
    Report Date
    July 1, 2004
    Manufacturer
    JOHNSON & JOHNSON
    Product Code
    NIQ
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    TX, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    EMERGENCY INTERVENTION PERFORMED ON CIRCUMFLEX WITH DES. THE NEXT DAY INTERVENTION PERFORMED ON LAD WITH DES. TWENTY-FOUR DAYS LATER FOUND TO BE OCCLUDED. ANGIOJET AND PTCA PERFORMED. POST PROCEDURE PT SUFFERED COMPLICATION CAUSING A RETROPERITONEAL BLEED. PRONOUNCED DEAD AT 7:25 PM.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 J & J CORDIS CYPHER ELUTING STENT NIQ JOHNSON & JOHNSON CXS18250 A0104013

    Patients

    Seq Age Sex Outcome Treatment
    1 73 YR Death| H| R