BEUDAMED
    FDA Adverse Event Injury Summary report: N

    PROSTAR XL SUTURE MEDIATED CLOSURE

    MDR report key: 1748896 · Received July 6, 2010

    Report

    Report Number
    2953144-2010-01267
    Event Type
    Injury
    Date Received
    July 6, 2010
    Date of Event
    June 11, 2010
    Report Date
    June 11, 2010
    Manufacturer
    ABBOTT VASCULAR REDWOOD CITY
    Product Code
    MGB
    PMA / PMN Number
    P960043
    Removal / Correction Number
    NA
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CA, US
    Reporter Occupation
    PHYSICIAN

    Narratives

    Additional Manufacturer Narrative · 1

    (B) (4). (B) (4). DEVICE #2: PART # 12322-01, LOT #87012-6H INDICATED IS BEING FILED UNDER A SEPARATE MEDWATCH MFR NUMBER. THE CUSTOMER REPORTED THE DEVICE WAS DISCARDED. THE LOT NUMBER WAS PROVIDED. A REVIEW OF THE DEVICE HISTORY RECORD FOR THIS LOT DID NOT PRODUCE ANY FINDINGS RELEVANT TO THIS REPORT.

    Description of Event or Problem · 1

    DEVICE #1 ISSUE: FAILURE TO DEPLOY - NEEDLE. TIME OF DEVICE ISSUE: DURING VESSEL CLOSURE. ADVERSE EVENT: FAILURE TO ACHIEVE HEMOSTASIS. IT WAS REPORTED THAT A PHYSICIAN TRAINED IN THE USE OF THE PROSTAR XL DEVICE ATTEMPTED ARTERIOTOMY CLOSURE OF A HEAVILY TORTUOUS LEFT COMMON FEMORAL ARTERY AFTER AN INTERVENTIONAL PROCEDURE. REPORTEDLY, DURING NEEDLE DEPLOYMENT, ONE OF THE FOUR NEEDLES DID NOT EMERGE AT THE TOP OF THE BARREL. THE NEEDLES WERE BACKED DOWN AND THE DEVICE WAS REMOVED OVER A GUIDE WIRE. A SECOND PROSTAR XL DEVICE WAS ATTEMPTED WITH THE SAME RESULTS. A THIRD PROSTAR XL DEVICE WAS USED TO ACHIEVE HEMOSTASIS. THERE WERE NO REPORTED ADVERSE PT EFFECTS. THOUGH REQUESTED, NO ADDITIONAL INFO WAS PROVIDED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 PROSTAR XL SUTURE MEDIATED CLOSURE MGB ABBOTT VASCULAR REDWOOD CITY NA 87012-6H

    Patients

    Seq Age Sex Outcome Treatment
    1 83 YR Required Intervention DEVICE #2, PROSTAR, PART # 12322-01, LOT #87012-6H