BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    TERUMO ADVANCED PERFUSION SYSTEM 1

    MDR report key: 1980022 · Received January 24, 2011

    Report

    Report Number
    1828100-2011-00139
    Event Type
    Malfunction
    Date Received
    January 24, 2011
    Date of Event
    January 12, 2011
    Report Date
    January 24, 2011
    Manufacturer
    TERUMO CARDIOVASCULAR SYSTEMS CORP
    Product Code
    DTQ
    PMA / PMN Number
    K022947
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    MI, US
    Reporter Occupation
    NOT APPLICABLE

    Narratives

    Additional Manufacturer Narrative · 1

    EVAL IN PROGRESS, BUT NOT YET CONCLUDED.

    Description of Event or Problem · 1

    DURING ROUTINE TESTING OF THE DEVICE AT THE SERVICE CENTER, THE SERVICE TECHNICIAN REPORTED A BROKEN CLAMP KNOB AND BENT VESA PLATE ON THE CENTRAL CONTROL MONITOR DISPLAY MOUNTING ARM. NO OTHER DETAILS REGARDING THE NATURE OF THE EVENT WERE PROVIDED. SINCE THE EVENT OCCURRED DURING ROUTING TESTING OF THE DEVICE, THERE WAS NO PT INVOLVEMENT DURING THIS EVENT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 TERUMO ADVANCED PERFUSION SYSTEM 1 ASSEMBLY, QCU DISPLAY MOUNTING ARM DTQ TERUMO CARDIOVASCULAR SYSTEMS CORP 801441

    Patients

    Seq Age Sex Outcome Treatment
    1