BEUDAMED
    FDA Adverse Event Death Summary report: N

    GORE

    MDR report key: 653615 · Received August 25, 2005

    Report

    Report Number
    MW1036431
    Event Type
    Death
    Date Received
    August 25, 2005
    Date of Event
    August 8, 2005
    Report Date
    August 23, 2005
    Manufacturer
    GORE
    Product Code
    DSY
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    CA, US
    Reporter Occupation
    PHYSICIAN

    Narratives

    Description of Event or Problem · 1

    ENDOLUMINAL STENTING. ANGIO AND CT EVIDENCE OF L CAROTID BEING UNOBSTRUCTED; PT ALSO NEURO O.K. THREE DAYS LATER L CVA (SMALL) FOLLOWED 1 WEEK LATER BY LARGE L CVA. POST-MORTEM REVEALED SLIPPAGE OF GRAFT WITH SLIPPAGE OF SHEATH BOTH PROX DO L CAROTID.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 GORE TAG DSY GORE * *

    Patients

    Seq Age Sex Outcome Treatment
    1 60 YR Death