BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    TERUMO ADVANCED PERFUSION SYSTEM 1

    MDR report key: 1941243 · Received December 22, 2010

    Report

    Report Number
    1828100-2010-02686
    Event Type
    Malfunction
    Date Received
    December 22, 2010
    Date of Event
    December 1, 2010
    Report Date
    December 22, 2010
    Manufacturer
    TERUMO CARDIOVASCULAR SYSTEMS CORP.
    Product Code
    DTQ
    PMA / PMN Number
    K022947
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    OH, US
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 1

    EVAL IN PROGRESS, BUT NOT YET CONCLUDED.

    Description of Event or Problem · 1

    DURING PRIMING OF THE DEVICE IN PREPARATION FOR USE FOR A CARDIOPULMONARY BYPASS PROCEDURE, THE USER REPORTED THE LEVEL MODULE GENERATED A "LEVEL DISCONNECT" ALARM. THE DEVICE WAS NOT CHANGED OUT FOR THE PROCEDURE. THE USER REPORTED THE SURGICAL PROCEDURE WAS COMPLETED SUCCESSFULLY, AND THERE WERE NO ADVERSE CONSEQUENCES TO THE PT AS A RESULT OF THIS EVENT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 TERUMO ADVANCED PERFUSION SYSTEM 1 HEART LUNG CONSOLE LEVEL MODULE DTQ TERUMO CARDIOVASCULAR SYSTEMS CORP. 802111

    Patients

    Seq Age Sex Outcome Treatment
    1