BEUDAMED
    FDA Adverse Event Death Summary report: N

    VENTAK MINI III

    MDR report key: 683480 · Received November 7, 2003

    Report

    Report Number
    2124215-2003-06253
    Event Type
    Death
    Date Received
    November 7, 2003
    Date of Event
    September 29, 2003
    Report Date
    September 29, 2003
    Manufacturer
    CARDIAC PACEMAKERS, INC
    Product Code
    LWS
    Removal / Correction Number
    NA
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    MN, US
    Reporter Occupation
    LAY USER/PATIENT

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 VENTAK MINI III IMPLANTABLE CARDIOVERTER DEFIBRILLATOR LWS CARDIAC PACEMAKERS, INC 1782 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 53 YR Death