BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    IAB : 8 FR - 40 CC

    MDR report key: 1230387 · Received November 7, 2008

    Report

    Report Number
    1219856-2008-00503
    Event Type
    Malfunction
    Date Received
    November 7, 2008
    Date of Event
    October 15, 2008
    Report Date
    November 7, 2008
    Manufacturer
    ARROW INTL., INC.
    Product Code
    DSP
    PMA / PMN Number
    K000729
    Removal / Correction Number
    NA
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    KS
    Reporter Occupation
    UNKNOWN

    Narratives

    Additional Manufacturer Narrative · 1

    FOLLOW-UP REPORT WILL BE FILED IF ADD'L INFO BECOMES AVAILABLE.

    Description of Event or Problem · 1

    IT WAS REPORTED THAT WHILE IN THE CATH LAB THE INTRA-AORTIC BALLOON (IAB) WAS PREPPED PER INSTRUCTION. THE SHEATH WAS INSERTED VIA THE LEFT FEMORAL ARTERY. AS THE MD WAS INSERTING THE IAB INTO THE SHEATH, IT BECAME STUCK. THE MD REMOVED THE IAB AND THE SHEATH AS ONE UNIT. ANOTHER IAB IAB WAS INSERTED WITHOUT DIFFICULTY. THE MD STATED THAT "THIS ISSUE CAUSED THE PROCEDURE TO BE DELAYED AT THE EMERGENCY SITUATION."

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 IAB : 8 FR - 40 CC INTRA-AORTIC BALLOON PRODUCTS DSP ARROW INTL., INC. MF8029191

    Patients

    Seq Age Sex Outcome Treatment
    1 UNK