BEUDAMED
    FDA Adverse Event Death Summary report: N

    BARD

    MDR report key: 622926 · Received February 4, 2005

    Report

    Report Number
    MW1036100
    Event Type
    Death
    Date Received
    February 4, 2005
    Manufacturer
    C.R. BARD INC.
    Product Code
    DTK
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    IL, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    MW1034425 AND MW1034685 WERE THE SAME PT AND THE SAME EVENT. THE CAUSES OF DEATH IN THE AUTOPSY REPORT WERE MULTI-SYSTEM FAILURE, CARDIOMYOPATHY AND RIGHT PULMONARY CONSOLIDATION.

    Description of Event or Problem · 1

    PT 23 DAYS S/P GASTRIC BYPASS SURGERY W/ HX OF PROPHYLACTIC IVC FILTER PLACEMENT 6 MOS EARLIER. UNEXPECTED EXPIRATION, PRONG FROM IVC FILTER FOUND IN PULMONARY ARTERY ON AUTOPSY.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 BARD RECOVERY FILTER SYSTEM (IVC) DTK C.R. BARD INC. RF-048F GF0C4546

    Patients

    Seq Age Sex Outcome Treatment
    1 52 YR Death