BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    CS100

    MDR report key: 2191835 · Received July 29, 2011

    Report

    Report Number
    2249723-2011-00123
    Event Type
    Malfunction
    Date Received
    July 29, 2011
    Date of Event
    June 4, 2011
    Report Date
    June 6, 2011
    Manufacturer
    DATASCOPE CORP.,
    Product Code
    DSP
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    WA, US
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 1

    THE COMPANY REP REPLACED THE BATTERY (PART NUMBER (B)(4)). THE UNIT WAS TESTED TO FACTORY SPEC. IT FUNCTIONED NORMALLY AND WAS RETURNED TO THE CUSTOMER. A REVIEW OF THE DEVICE'S SERVICE HISTORY DOES NOT INDICATE ANY SYSTEMIC ISSUES.

    Description of Event or Problem · 1

    THE CUSTOMER REPORTED THAT WHILE THE UNIT WAS IN USE ON A PT DURING TRANSPORT IN AN AMBULANCE THE UNIT DISPLAYED A "LOW BATTERY" ALARM. THEY CONNECTED THE PUMP TO AN AC POWER OUTLET, BUT THE OUTLET WAS NOT FUNCTIONING. THE UNIT SHUT DOWN. NO PT INJURY WAS REPORTED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 CS100 INTRA-AORTIC BALLOON PUMP DSP DATASCOPE CORP., CS100

    Patients

    Seq Age Sex Outcome Treatment
    1 UNK