BEUDAMED
    FDA Adverse Event Death Summary report: N

    SYNCHROMED EL

    MDR report key: 655228 · Received December 19, 2005

    Report

    Report Number
    6000030-2005-01967
    Event Type
    Death
    Date Received
    December 19, 2005
    Date of Event
    October 20, 2005
    Report Date
    November 22, 2005
    Manufacturer
    RICE CREEK MANUFACTURING
    Product Code
    LKK
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    TX, US
    Reporter Occupation
    PHYSICIAN

    Narratives

    Description of Event or Problem · 1

    DEVICE REGISTRATION SYSTEM INDICATES PT EXPIRED. CAUSE OF DEATH IS UNK AT THE TIME OF THIS REPORT DESPITE SEVERAL ATTEMPTS TO OBTAIN THIS INFO. THIS EVENT PREVIOUSLY REPORTED ON MFR'S SUPPLEMENTAL REPORT # 6000032-2005-01691.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 SYNCHROMED EL PUMP LKK RICE CREEK MANUFACTURING 862718 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 76 YR Death