BEUDAMED
    FDA Adverse Event Death Summary report: N

    VENTAK PRIZM 2 DR

    MDR report key: 683563 · Received November 7, 2003

    Report

    Report Number
    2124215-2003-06165
    Event Type
    Death
    Date Received
    November 7, 2003
    Date of Event
    April 18, 2003
    Report Date
    September 18, 2003
    Manufacturer
    CARDIAC PACEMAKERS, INC
    Product Code
    LWS
    Removal / Correction Number
    NA
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    US
    Reporter Occupation
    LAY USER/PATIENT

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 VENTAK PRIZM 2 DR IMPLANTABLE CARDIOVERTER DEFIBRILLATOR LWS CARDIAC PACEMAKERS, INC 1861 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 71 YR Death