BEUDAMED
    FDA Adverse Event Injury Summary report: N

    HEARTMATE II LVAS

    MDR report key: 2090264 · Received May 16, 2011

    Report

    Report Number
    2090264
    Event Type
    Injury
    Date Received
    May 16, 2011
    Date of Event
    April 14, 2011
    Report Date
    August 9, 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: BLOOD PUMPSPECIFIC COMPONENT(S) INVOLVED: DRIVELINE MALFUNCTION

    Description of Event or Problem · 1

    MAJOR PUMP UNIT(S) INVOLVED: BLOOD PUMP. ADDITIONAL TEXT: DEVICE FAILURE. SPECIFIC COMPONENT(S) INVOLVED: DRIVELINE MALFUNCTION. ADDITIONAL TEXT: DRIVELINE SEVERED CAUSING PUMP STOPPAGE. OTHER COMPONENT: CAUSATIVE OR CONTRIBUTING FACTOR: PATIENT NONCOMPLIANCE IN DEVICE MAINTENANCE AND PROTECTION; PATIENT ERROR IN CARING FOR SYSTEM. OTHER CAUSE: INTERVENTION(S): OTHER INTERVENTIONS, SPECIFY. OTHER INTERVENTION : DEVICE EXPLANTATION. IMPLANT DEVICE TYPE: LVAD.

    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 28 YR