FDA Adverse Event Malfunction Summary report: N

HEATER-COOLER SYSTEM 3T

MDR report key: 13577822 · Received February 22, 2022

Report

Report Number
9611109-2022-00075
Event Type
Malfunction
Date Received
February 22, 2022
Date of Event
January 25, 2022
Report Date
February 22, 2022
Manufacturer
LIVANOVA DEUTSCHLAND
Product Code
DWC
UDI-DI
04033817901099
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
GM
Reporter Occupation
OTHER HEALTH CARE PROFESSIONAL
Health Professional
Yes

Narratives

Additional Manufacturer Narrative · 0

THERE WAS NO PATIENT INVOLVEMENT. THE HEATER-COOLER 16-02-80 IS NOT DISTRIBUTED IN THE USA AND IT IS SIMILAR TO HEATER-COOLER 16-02-85, WHICH IS DISTRIBUTED IN THE USA (510(K) NUMBER: K191402). LIVANOVA (B)(4) MANUFACTURES THE HEATER-COOLER SYSTEM 3T. THE INCIDENT OCCURRED IN (B)(6). A LIVANOVA FIELD SERVICE REPRESENTATIVE WAS DISPATCHED TO THE FACILITY TO INVESTIGATE THE DEVICE AND FOUND NO ERROR ON THE STIRRER MOTOR. HOWEVER, HE FOUND THAT THE PATIENT PUMP 1 WAS STUCK. THE PUMP WAS REPLACED AS WELL AS THE DISTRIBUTION BOARD AND ISSUE COULD BE SOLVED. SUBSEQUENT FUNCTIONAL VERIFICATION TESTING WAS COMPLETED WITHOUT FURTHER ISSUES AND THE UNIT WAS RETURNED TO SERVICE. IF ANY ADDITIONAL INFORMATION PERTINENT TO THE REPORTED EVENT IS RECEIVED, IT WILL BE PROVIDED IN A SUPPLEMENTAL REPORT.

Additional Manufacturer Narrative · 0

THERE WAS NO PATIENT INVOLVEMENT. THE HEATER-COOLER 16-02-80 IS NOT DISTRIBUTED IN THE USA AND IT IS SIMILAR TO HEATER-COOLER 16-02-85, WHICH IS DISTRIBUTED IN THE USA (510(K) NUMBER: K191402). LIVANOVA (B)(4) MANUFACTURES THE HEATER-COOLER SYSTEM 3T. THE INCIDENT OCCURRED IN (B)(6). A LIVANOVA FIELD SERVICE REPRESENTATIVE WAS DISPATCHED TO THE FACILITY TO INVESTIGATE THE DEVICE AND FOUND NO ERROR ON THE STIRRER MOTOR. HOWEVER, HE FOUND THAT THE PATIENT PUMP 1 WAS STUCK. THE PUMP WAS REPLACED AS WELL AS THE DISTRIBUTION BOARD AND ISSUE COULD BE SOLVED. SUBSEQUENT FUNCTIONAL VERIFICATION TESTING WAS COMPLETED WITHOUT FURTHER ISSUES AND THE UNIT WAS RETURNED TO SERVICE. IF ANY ADDITIONAL INFORMATION PERTINENT TO THE REPORTED EVENT IS RECEIVED, IT WILL BE PROVIDED IN A SUPPLEMENTAL REPORT.

Additional Manufacturer Narrative · 0

H.10: IN THE INITIAL REPORT IT WAS STATED THAT: "A LIVANOVA FIELD SERVICE REPRESENTATIVE WAS DISPATCHED TO THE FACILITY TO INVESTIGATE THE DEVICE AND FOUND NO ERROR ON THE STIRRER MOTOR. HOWEVER, HE FOUND THAT THE PATIENT PUMP 1 WAS STUCK. THE PUMP WAS REPLACED AS WELL AS THE DISTRIBUTION BOARD AND ISSUE COULD BE SOLVED. SUBSEQUENT FUNCTIONAL VERIFICATION TESTING WAS COMPLETED WITHOUT FURTHER ISSUES AND THE UNIT WAS RETURNED TO SERVICE. " THROUGH FOLLOW UP COMMUNICATION LIVANOVA LEARNED THAT THE ABOVE ACTIVITY WAS REPORTED INCORRECTLY. PLEASE CONSIDER VALID THE STATEMENT BELOW: "A LIVANOVA FIELD SERVICE REPRESENTATIVE WAS DISPATCHED TO THE FACILITY TO INVESTIGATE THE DEVICE AND FOUND NO ERROR ON THE STIRRER MOTOR. HOWEVER, HE FOUND THAT THE PATIENT PUMP 1 WAS STUCK. THE PUMP COULD BE ROTATED ONCE PUSHED BY HAND THUS IT WAS NOT REPLACED AND THE ISSUE COULD BE SOLVED. THE DISTRIBUTION BOARD WAS CHANGED WITH ANOTHER. SUBSEQUENT FUNCTIONAL VERIFICATION TESTING WAS COMPLETED WITHOUT FURTHER ISSUES AND THE UNIT WAS RETURNED TO SERVICE." IF ANY ADDITIONAL INFORMATION PERTINENT TO THE REPORTED EVENT IS RECEIVED, IT WILL BE PROVIDED IN A SUPPLEMENTAL REPORT.

Additional Manufacturer Narrative · 0

H.10: THE MOST LIKELY ROOT CAUSE OF THE REPORTED ISSUE IS ASSOCIATED TO MOTOR BEARING CORROSION, WHICH CONSEQUENTLY DOES NOT ALLOW THE MOTOR SHAFT TO ROTATE FREELY. POSSIBLE CAUSES ARE WATER INFILTRATION OR WATER FORMATION DUE TO CONDENSATION OR HIGH TEMPERATURES AND HIGH LEVEL OF HUMIDITY IN THE STATIONARY PHASE. CAUSES RELATED TO ENVIRONMENTAL CONDITIONS.

Description of Event or Problem · 0

LIVANOVA (B)(4) RECEIVED A REPORT THAT A HEATER-COOLER SYSTEM 3T DISPLAYED AN ERROR MESSAGE ASSOCIATED TO THE STIRRER MOTOR ON THE PATIENT CIRCUIT DURING PRIMING.THERE WAS NO PATIENT INVOLVEMENT.

Description of Event or Problem · 0

LIVANOVA (B)(4) RECEIVED A REPORT THAT A HEATER-COOLER SYSTEM 3T DISPLAYED AN ERROR MESSAGE ASSOCIATED TO THE STIRRER MOTOR ON THE PATIENT CIRCUIT DURING PRIMING.THERE WAS NO PATIENT INVOLVEMENT.

Description of Event or Problem · 0

SEE INITIAL REPORT.

Description of Event or Problem · 0

SEE INITIAL REPORT.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1005761 HEATER-COOLER SYSTEM 3T CONTROLLER, TEMPERATURE, CARDIOPULMONARY BYPASS DWC LIVANOVA DEUTSCHLAND 16-02-80 04033817901099

Patients

Seq Age Sex Outcome Treatment
1 Unknown