FDA Adverse Event Death Summary report: N

HEATER COOLER 3T

MDR report key: 17450293 · Received August 3, 2023

Report

Report Number
9611109-2023-00378
Event Type
Death
Date Received
August 3, 2023
Date of Event
November 15, 2012
Report Date
March 4, 2024
Manufacturer
LIVANOVA DEUTSCHLAND GMBH
Product Code
DWC
Removal / Correction Number
Z-2076/2081-2015
Adverse Event
Yes
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
UK
Reporter Occupation
OTHER
Health Professional
N

Narratives

Additional Manufacturer Narrative · 0

A.2-A.5. PATIENT INFORMATION WAS NOT PROVIDED D.4. THE CATALOGUE AND SERIAL NUMBER ARE UNKNOWN. THEREFORE UDI IS UNKNOWN. INFORMATION WILL BE PROVIDED IN A SUPPLEMENTAL REPORT IF MADE AVAILABLE. G.5. THE HEATER-COOLER OBJECT OF THE EVENT IS NOT DISTRIBUTED IN THE USA, BUT IT IS SIMILAR TO HEATER-COOLER 16-02-85, WHICH IS DISTRIBUTED IN THE USA (510(K) NUMBER: K191402). H.4. AS THE SERIAL NUMBER IS UNKNOWN, THE DEVICE MANUFACTURE DATE COULD NOT BE DETERMINED. THIS INFORMATION WILL BE PROVIDED IN A SUPPLEMENTAL REPORT IF MADE AVAILABLE. H.9. LIVANOVA DEUTSCHLAND IMPLEMENTED A FIELD SAFETY NOTICE FOR DISINFECTION AND CLEANING OF HEATER-COOLER DEVICES. THE Z NUMBER IS Z-2076/2081-2015. H10: LIVANOVA DEUTSCHLAND MANUFACTURES THE HEATER-COOLER SYSTEM 3T . THE INCIDENT OCCURRED IN UNITED KINGDOM. LIVANOVA INITIATED AN INVESTIGATION. IF ANY ADDITIONAL INFORMATION PERTINENT TO THE REPORTED EVENT IS RECEIVED, IT WILL BE PROVIDED IN A SUPPLEMENTAL REPORT.

Additional Manufacturer Narrative · 0

H10: THROUGH FOLLOW UP COMMUNICATION, LIVANOVA LEARNED THAT POSSIBLE INVOLVED DEVICE SERIAL NUMBERS COULD BE THE FOLLOWING: (B)(6) (MODEL: 16-02-80). NO OTHER INFORMATION HAS BEEN MADE AVAILABLE FROM THE CUSTOMER. DEVICE HISTORY RECORDS (DHRS) REVIEW OF POSSIBLE INVOLVED DEVICE SERIAL NUMBERS HAS BEEN COMPLETED AND DID NOT IDENTIFY ANY DEVIATION OR NON-CONFORMITY RELEVANT TO THE REPORTED ISSUE. NO DEVICE, BETWEEN THE ONES POSSIBLE INVOLVED AND IN USE AT THE HOSPITAL AT THE TIME OF SURGERY (2012), WAS UPGRADED WITH VACUUM AND SEALING KIT. NO FURTHER INVESTIGATION IS POSSIBLE. SOURCE OF PATIENT CONTAMINATION REMAINS UNKNOWN AND A DIRECT RELATIONSHIP BETWEEN THE REPORTED ADVERSE EVENT AND THE DEVICE COULD NOT BE ESTABLISHED.

Additional Manufacturer Narrative · 0

H10: THROUGH FOLLOW-UP COMMUNICATION, LIVANOVA LEARNED THAT AN ARTICLE RELATED TO THE ISSUE WAS PUBLISHED, ADDING THE FOLLOWING FURTHER INFORMATION. THE AFFECTED PATIENT DIED LAST YEAR AT THE AGE OF 59 AT (B)(6) (BRISTOL), ONLY STARTED SHOWING SYMPTOMS OF THE INFECTION FIVE (5) YEARS AFTER SURGERY, IN THE FORM OF NIGHT SWEATS. ONE OR TWO YEARS LATER, HE WAS DIAGNOSED WITH MYCOBACTERIUM CHIMAERA AND BEGAN TREATMENT FOR THREE (3) YEARS BEFORE DYING IN (B)(6) 2022.

Description of Event or Problem · 0

THE EVENT WAS IDENTIFIED THROUGH A RETROSPECTIVE REVIEW OF PRODUCT LIABILITY LAWSUITS. THROUGH THIS REVIEW, WE HAVE IDENTIFIED A FEW EVENTS WHERE THE PLAINTIFF HAD FILED A SUIT AGAINST THE COMPANY, AND IT WAS HANDLED BY OUR LEGAL DEPARTMENT, BUT THE UNDERLYING PRODUCT INFORMATION HAD NOT BEEN FORWARDED TO THE COMPLAINT HANDLING UNIT. LIVANOVA OPENED A CAPA TO IDENTIFY ANY POSSIBLE LAWSUITS THAT MIGHT REQUIRE COMPLAINT REPORTING AND TO RETROSPECTIVELY SUBMIT THOSE EVENTS THAT WERE NOT PREVIOUSLY SUBMITTED AND TO PREVENT FUTURE SIMILAR ISSUES FROM OCCURRING. THE COMPLAINANT ALLEGES THROUGH THEIR COUNSEL OF A MICROBIAL CONTAMINATION. BASED ON THE CURRENT STATUS OF THE INVESTIGATION THE ALLEGED DEVICE ISSUE WAS NOT YET CONFIRMED. OPERATION ON (B)(6) 2012 AT (B)(6).

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
1698796 HEATER COOLER 3T CONTROLLER, TEMPERATURE, CARDIOPULMONARY BYPASS DWC LIVANOVA DEUTSCHLAND GMBH UNKNOWN
2183557 HEATER COOLER 3T CONTROLLER, TEMPERATURE, CARDIOPULMONARY BYPASS DWC LIVANOVA DEUTSCHLAND GMBH UNKNOWN

Patients

Seq Age Sex Outcome Treatment
1 NA Male Death