BEUDAMED
    FDA Adverse Event Death Summary report: N

    HEARTWARE VENTRICULAR ASSIST SYSTEM - PUMP

    MDR report key: 11089475 · Received December 29, 2020

    Report

    Report Number
    3007042319-2020-08047
    Event Type
    Death
    Date Received
    December 29, 2020
    Date of Event
    September 27, 2020
    Report Date
    February 23, 2026
    Manufacturer
    HEARTWARE, INC.
    Product Code
    DSQ
    UDI-DI
    00888707003261
    PMA / PMN Number
    P100047
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    VA, US
    Reporter Occupation
    PHYSICIAN
    Health Professional
    Yes

    Narratives

    Additional Manufacturer Narrative · 0

    A SUPPLEMENTAL REPORT IS BEING SUBMITTED FOR INVESTIGATION COMPLETION. PRODUCT EVENT SUMMARY: THE VENTRICULAR ASSIST DEVICE (VAD) WAS NOT RETURNED FOR EVALUATION. THIS COMPLAINT IS ASSOCIATED WITH A CLINICAL ADVERSE EVENT. INFORMATION PROVIDED BY THE SITE INDICATED THAT THE PATIENT WAS ADMITTED DUE TO EXPERIENCING BIVENTRICULAR AND RIGHT HEART FAILURE ASSOCIATED WITH ONGOING PRESSURE AND WALL CHANGES. THE PATIENT RECEIVED MILRINONE AND REQUIRED A MILRINONE INFUSION THROUGHOUT THEIR ADMISSION. THE PATIENT WAS RE-ADMITTED FOR COMPLEX CARE MANAGEMENT AND THE PATIENT'S DECLINING STATUS. ALL MEDICATION WERE DISCONTINUED, THE PATIENT'S BIVENTRICULAR IMPLANTABLE CARDIOVERTER DEFIBRILLATOR (ICD) AND THE VAD WERE TURNED OFF. THE GOAL OF CARE BECAME COMFORT AND THE PATIENT SUBSEQUENTLY DIED. BASED ON THE AVAILABLE INFORMATION, THERE IS NO EVIDENCE TO INDICATE THAT A DEVICE MALFUNCTION OR PERFORMANCE ISSUE CAUSED OR CONTRIBUTED TO THE REPORTED EVENT. PER THE INSTRUCTIONS FOR USE, RIGHT HEART FAILURE AND DEATH ARE KNOWN POTENTIAL COMPLICATIONS ASSOCIATED WITH THE IMPLANTATION OF A VAD. POSSIBLE CLINICAL FACTORS THAT MAY HAVE CONTRIBUTED TO THIS EVENT INCLUDE THE PATIENT¿S PRE-EXISTING HISTORY AND RELATED COMORBIDITIES, THE PROGRESSION OF THEIR UNDERLYING DISEASE, ISSUES RELATED TO THE THERAPEUTIC USE OF ANTICOAGULANT AND ANTIPLATELET MEDICATIONS AND THE PATIENT'S COMPLEX POST-OPERATIVE COURSE. THERE ARE POSSIBLE PATIENT, PHARMACOLOGICAL AND PROCEDURAL FACTORS THAT MAY HAVE CONTRIBUTED TO THIS EVENT. INVESTIGATION OF THIS EVENT IS COMPLETED AND THE FILE WILL BE CLOSED. IF NEW INFORMATION IS RECEIVED, THE FILE WILL BE RE-OPENED AND A SUPPLEMENTAL WILL BE SUBMITTED. MEDTRONIC IS SUBMITTING THIS REPORT TO COMPLY WITH FDA REPORTING REGULATIONS UNDER 21 CFR PARTS 4 AND 803. THIS REPORT IS BASED UPON INFORMATION OBTAINED BY MEDTRONIC, WHICH THE COMPANY MAY NOT HAVE BEEN ABLE TO FULLY INVESTIGATE OR VERIFY PRIOR TO THE DATE THE REPORT WAS REQUIRED BY THE FDA. MEDTRONIC HAS MADE REASONABLE EFFORTS TO OBTAIN MORE COMPLETE INFORMATION AND HAS PROVIDED AS MUCH RELEVANT INFORMATION AS IS AVAILABLE TO THE COMPANY AS OF THE SUBMISSION DATE OF THIS REPORT. THIS REPORT DOES NOT CONSTITUTE AN ADMISSION OR A CONCLUSION BY FDA, MEDTRONIC, OR ITS EMPLOYEES THAT THE DEVICE, MEDTRONIC, OR ITS EMPLOYEE CAUSED OR CONTRIBUTED TO THE EVENT DESCRIBED IN THE REPORT. IN PARTICULAR, THIS REPORT DOES NOT CONSTITUTE AN ADMISSION BY ANYONE THAT THE PRODUCT DESCRIBED IN THIS REPORT HAS ANY ¿DEFECTS¿ OR HAS ¿MALFUNCTIONED¿. THESE WORDS ARE INCLUDED IN THE FDA 3500A FORM AND ARE FIXED ITEMS FOR SELECTION CREATED BY THE FDA TO CATEGORIZE THE TYPE OF EVENT SOLELY FOR THE PURPOSE OF REGULATORY REPORTING. MEDTRONIC OBJECTS TO THE USE OF THESE WORDS AND OTHERS LIKE THEM BECAUSE OF THE LACK OF DEFINITION AND THE CONNOTATIONS IMPLIED BY THESE TERMS. THIS STATEMENT SHOULD BE INCLUDED WITH ANY INFORMATION OR REPORT DISCLOSED TO THE PUBLIC UNDER THE FREEDOM OF INFORMATION ACT. ANY REQUIRED FIELDS THAT ARE UNPOPULATED ARE BLANK BECAUSE THE INFORMATION IS CURRENTLY UNKNOWN OR UNAVAILABLE. A GOOD FAITH EFFORT WILL BE MADE TO OBTAIN THE APPLICABLE INFORMATION RELEVANT TO THE REPORT. IF INFORMATION IS PROVIDED IN THE FUTURE, A SUPPLEMENTAL REPORT WILL BE ISSUED.

    Additional Manufacturer Narrative · 1

    CONCOMITANT MEDICAL PRODUCTS: 6944-58 LEAD, IMPLANTED: (B)(6) 2007. THIS INFORMATION WAS RECEIVED FROM THE DESTINATION THERAPY POST APPROVAL STUDY. INVESTIGATION OF THIS EVENT IS PENDING AND A SUPPLEMENTAL REPORT WILL BE SENT UPON ITS COMPLETION. IF INFORMATION IS PROVIDED IN THE FUTURE, A SUPPLEMENTAL REPORT WILL BE ISSUED.

    Description of Event or Problem · 1

    IT WAS REPORTED THAT THE VENTRICULAR ASSIST DEVICE (VAD) PATIENT WAS ADMITTED DUE TO EXPERIENCING BIVENTRICULAR AND RIGHT HEART FAILURE ASSOCIATED WITH ONGOING PRESSURE AND WALL CHANGES. THE PATIENT RECEIVED MILRINONE AND REQUIRED A MILRINONE INFUSION THROUGHOUT THEIR ADMISSION. APPROXIMATELY THREE WEEKS LATER, THE PATIENT WAS DISCHARGED WITH HOME MILRINONE. SEVEN WEEKS LATER, THE PATIENT WAS RE-ADMITTED FOR COMPLEX CARE MANAGEMENT AND THE PATIENT'S DECLINING STATUS. APPROXIMATELY ONE WEEK LATER, THE PATIENT WAS MADE A DO NOT RESUSCITATE (DNR-C), ALL MEDICATION WERE DISCONTINUED, THE PATIENT'S BIVENTRICULAR IMPLANTABLE CARDIOVERTER DEFIBRILLATOR (ICD) WAS TURNED OFF, AND THE VAD WAS TURNED OFF. THE GOAL OF CARE BECAME COMFORT AND THE PATIENT SUBSEQUENTLY DIED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1555495 HEARTWARE VENTRICULAR ASSIST SYSTEM - PUMP VENTRICULAR (ASSIST) BYPASS DSQ HEARTWARE, INC. 1103 00888707003261

    Patients

    Seq Age Sex Outcome Treatment
    1 74 YR Death DTBA1Q1 ICD, 459888 LEAD, 5076-52 LEAD| DTBA1Q1 ICD, 459888 LEAD, 5076-52 LEAD