BEUDAMED
    FDA Adverse Event Death Summary report: N

    ACCENT DR RF PACEMAKER

    MDR report key: 6207683 · Received December 27, 2016

    Report

    Report Number
    2017865-2016-08018
    Event Type
    Death
    Date Received
    December 27, 2016
    Date of Event
    July 9, 2016
    Report Date
    November 30, 2016
    Manufacturer
    ST. JUDE MEDICAL, INC.(CRM-SYLMAR)
    Product Code
    LWP
    PMA / PMN Number
    P030035
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    FL, US
    Reporter Occupation
    PHYSICIAN

    Narratives

    Additional Manufacturer Narrative · 1

    (B)(4).

    Description of Event or Problem · 1

    IT WAS REPORTED THAT THE PATIENT WAS ADMITTED TO HOSPICE CARE ON (B)(6) 2016 FOR DECLINING HEALTH. ON (B)(6) 2016 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 REPORTED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    855199 ACCENT DR RF PACEMAKER IMPLANTABLE PACEMAKER PULSE GENERATOR LWP ST. JUDE MEDICAL, INC.(CRM-SYLMAR) PM2210 3410511

    Patients

    Seq Age Sex Outcome Treatment
    1 90 YR Death (B)(4)| (B)(4)