FDA Adverse Event Malfunction Summary report: N

ALLURA XPER FD

MDR report key: 11706224 · Received April 22, 2021

Report

Report Number
3003768277-2021-10013
Event Type
Malfunction
Date Received
April 22, 2021
Date of Event
March 25, 2021
Product Code
IZI
UDI-DI
00884838059054
PMA / PMN Number
K130842
Adverse Event
Yes
Report Source
Manufacturer report
Reporter Location
MX
Reporter Occupation
BIOMEDICAL ENGINEER

Narratives

Additional Manufacturer Narrative · 0

CORRECTED DATA: DEVICE PROBLEM CODE HAS BEEN UPDATED FROM C62904 TO C133569 ADDTL NARRATIVE: PHILIPS HAS INVESTIGATED THIS COMPLAINT. ACCORDING TO THE INFORMATION COLLECTED THE PROCEDURE WAS COMPLETED WITH THE ADDITIONAL SYSTEM. THE PATIENT WAS TAKEN TO THE CORONARY UNIT FOR CLOSE MEDICAL SURVEILLANCE FOR 2 DAYS. PHILIPS HAS BEEN CONFIRMED THAT THERE WAS NO HARM TO THE PATIENT. PHILIPS INSPECTED THE SYSTEM ONSITE AND ANALYZED THE LOG FILE AND IDENTIFIED A FAILURE OF THE IMAGE PROCESSING PC. THE DEFECTIVE IMAGE PROCESSING PC WAS REPLACED, AND THE SYSTEM WAS RETURNED TO USE IN GOOD WORKING ORDER.

Description of Event or Problem · 0

IT HAS BEEN REPORTED TO PHILIPS THAT DURING A CORONARY ANGIOPLASTY PROCEDURE X-RAY STOPPED WORKING, WHILE THE CATHETER WAS INSIDE THE PATIENT. THE PROCEDURE WAS COMPLETED USING A MOBILE X-RAY SYSTEM. THE PATIENT WAS MONITORED FOR 2 DAYS AT THE CORONARY UNIT. NO HARM TO THE PATIENT WAS REPORTED. PHILIPS HAS STARTED AN INVESTIGATION OF THIS COMPLAINT.

Description of Event or Problem · 1

IT HAS BEEN REPORTED TO PHILIPS THAT DURING A CORONARY ANGIOPLASTY PROCEDURE X-RAY STOPPED WORKING, WHILE THE CATHETER WAS INSIDE THE PATIENT. THE PROCEDURE WAS COMPLETED USING A MOBILE X-RAY SYSTEM. THE PATIENT WAS MONITORED FOR 2 DAYS AT THE CORONARY UNIT. NO HARM TO THE PATIENT WAS REPORTED. PHILIPS HAS STARTED AN INVESTIGATION OF THIS COMPLAINT.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
602678 ALLURA XPER FD SYSTEM, X-RAY, ANGIOGRAPHIC IZI ALLURA XPER FD20 00884838059054

Patients

Seq Age Sex Outcome Treatment
1 74 YR Hospitalization