BEUDAMED
    FDA Adverse Event Death Summary report: N

    ACCENT DR

    MDR report key: 6067604 · Received October 31, 2016

    Report

    Report Number
    2017865-2016-06873
    Event Type
    Death
    Date Received
    October 31, 2016
    Date of Event
    December 5, 2014
    Report Date
    October 14, 2016
    Manufacturer
    ST. JUDE MEDICAL, INC.(CRM-SYLMAR)
    Product Code
    LWP
    PMA / PMN Number
    P880086
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    AZ, US
    Reporter Occupation
    PHYSICIAN

    Narratives

    Additional Manufacturer Narrative · 1

    (B)(4)

    Description of Event or Problem · 1

    IT WAS REPORTED THAT THE PATIENT HAS DECEASED. THERE IS NO KNOWN ALLEGATION FROM A HEALTH CARE PROFESSIONAL THAT SUGGESTS 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
    719268 ACCENT DR IMPLANTABLE PACEMAKER PULSE GENERATOR LWP ST. JUDE MEDICAL, INC.(CRM-SYLMAR) PM2110 4035843

    Patients

    Seq Age Sex Outcome Treatment
    1 91 YR Death 2088TC/46, (B)(4)| 2088TC/52, (B)(4)