FDA Adverse Event Death Summary report: N

CORMATRIX ECM FOR CARDIAC TISSUE REPAIR

MDR report key: 1659878 · Received April 14, 2010

Report

Report Number
3005619880-2010-00005
Event Type
Death
Date Received
April 14, 2010
Date of Event
September 30, 2009
Report Date
March 14, 2010
Manufacturer
CORMATRIX CARDIOVASCULAR, INC.
Product Code
DXZ
PMA / PMN Number
K063349
Adverse Event
Yes
Report Source
Manufacturer report
Reporter Location
FL, US
Reporter Occupation
PHYSICIAN

Narratives

Description of Event or Problem · 1

ON (B) (6) 2010, A PT DEATH WAS REPORTED TO CORMATRIX CARDIOVASCULAR. THE PHYSICIAN STATED THAT THIS WAS A VERY HIGH RISK PEDIATRIC CASE WHO HAD SEVERE, COMPLEX HEART DEFECTS. THE PT WAS DIAGNOSED WITH HYPOPLASTIC LEFT HEART SYNDROME AND SEVERE AORTIC ATRESIA. ON (B) (6) 2010, THE PT UNDERWENT A NORWOOD PROCEDURE AND RECONSTRUCTION OF THE AORTA AND PULMONARY ARTERY. THE CORMATRIX ECM WAS USED FOR PULMONARY ARTERY RECONSTRUCTION AND AORTIC PATCH RECONSTRUCTION. THE PHYSICIAN REPORTED THAT FOLDS IN THE ECM DEVELOPED AND DURING REMODELING, THE FOLDS THICKENED. ON (B) (6) 2009, THE PT RETURNED FOR RE-OPERATION AND DIED DURING SURGERY FROM PROGRESSIVE HEART DYSFUNCTION. THE CORMATRIX ECM FOR CARDIAC TISSUE REPAIR PRODUCT WAS NOT RETURNED TO CORMATRIX FOR INVESTIGATION. IT COULD NOT BE DETERMINED WHETHER THE CORMATRIX ECM CONTRIBUTED TO THE PT'S DEATH. AS THE PHYSICIAN STATED, THE PEDIATRIC PT HAD VERY SEVERE HEART DEFECTS.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1 CORMATRIX ECM FOR CARDIAC TISSUE REPAIR PATCH, PLEDGET AND INTRACARDIAC, PETP DXZ CORMATRIX CARDIOVASCULAR, INC. CMCV-002

Patients

Seq Age Sex Outcome Treatment
1 Death