BEUDAMED
    FDA Adverse Event Injury Summary report: N

    HEARTMATE II LVAS

    MDR report key: 2013436 · Received March 10, 2011

    Report

    Report Number
    2013436
    Event Type
    Injury
    Date Received
    March 10, 2011
    Date of Event
    August 23, 2010
    Report Date
    May 24, 2011
    Manufacturer
    THORATEC CORPORATION
    Product Code
    DSQ
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    AL, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    MAJOR PUMP UNIT(S) INVOLVED: DRIVE UNIT FAILURESPECIFIC COMPONENT(S) INVOLVED: DRIVELINE MALFUNCTION

    Description of Event or Problem · 1

    MAJOR PUMP UNIT(S) INVOLVED: DRIVE UNIT FAILUREADDITIONAL TEXT: DRIVELINE SEPARATED FROM METAL CONNECTORSPECIFIC COMPONENT(S) INVOLVED: DRIVELINE MALFUNCTIONADDITIONAL TEXT: (B)(4)OTHER COMPONENT:CAUSATIVE OR CONTRIBUTING FACTOR: NO SPECIFIC CONTRIBUTING CAUSE IDENTIFIEDOTHER CAUSE:INTERVENTION(S): OTHER INTERVENTIONS, SPECIFYOTHER INTERVENTION : CLAM SHELL REPAIR BY CLINICAL SPECIALISTIMPLANT DEVICE TYPE: LVADMALFUNCTION DEVICE TYPE:

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 HEARTMATE II LVAS LVAD DSQ THORATEC CORPORATION

    Patients

    Seq Age Sex Outcome Treatment
    1 31 YR