BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    TERUMO ADVANCED PERFUSION SYSTEM I

    MDR report key: 2100554 · Received May 13, 2011

    Report

    Report Number
    1828100-2011-01305
    Event Type
    Malfunction
    Date Received
    May 13, 2011
    Date of Event
    April 18, 2011
    Report Date
    May 13, 2011
    Manufacturer
    TERUMO CARDIOVASCULAR SYSTEMS CORP
    Product Code
    DTQ
    PMA / PMN Number
    K022947
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CA, US
    Reporter Occupation
    NOT APPLICABLE

    Narratives

    Description of Event or Problem · 1

    DURING PREVENTATIVE MAINTENANCE OF THE DEVICE, THE FIELD SERVICE REP REPORTED THAT THE OCCLUDER INDICATOR RING WAS BROKEN. SINCE THE EVENT OCCURRED DURING PREVENTATIVE MAINTENANCE, THERE WAS NO PT INVOLVEMENT DURING THIS EVENT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 TERUMO ADVANCED PERFUSION SYSTEM I ROLLER PUMP DTQ TERUMO CARDIOVASCULAR SYSTEMS CORP 801041

    Patients

    Seq Age Sex Outcome Treatment
    1