BEUDAMED
    FDA Adverse Event Death Summary report: N

    VICTORY XL DR

    MDR report key: 5992767 · Received October 1, 2016

    Report

    Report Number
    2017865-2016-06334
    Event Type
    Death
    Date Received
    October 1, 2016
    Date of Event
    October 21, 2013
    Report Date
    September 9, 2016
    Manufacturer
    ST. JUDE MEDICAL, INC.(CRM-SYLMAR)
    Product Code
    LWP
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    GA, US
    Reporter Occupation
    PHYSICIAN

    Narratives

    Additional Manufacturer Narrative · 1

    (B)(4).

    Description of Event or Problem · 1

    IT WAS REPORTED THAT THE PATIENT DECEASED. THERE IS NO KNOWN ALLEGATION FROM A HEALTH CARE PROFESSIONAL THAT SUGGESTS THAT THE DEATH WAS DEVICE RELATED. THE CAUSE OF DEATH WAS UNKNOWN. NO ADDITIONAL INFORMATION WAS AVAILABLE AT THIS TIME.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    644181 VICTORY XL DR IMPLANTABLE PACEMAKER PULSE GENERATOR LWP ST. JUDE MEDICAL, INC.(CRM-SYLMAR) 5810 2809917

    Patients

    Seq Age Sex Outcome Treatment
    1 89 YR Death 1888TC/46, (B)(4)| 1888TC/52, (B)(4)