FDA Adverse Event Summary report: N

TERUMO VIRTUOSAPH VEIN HARVESTING SYSTEM

MDR report key: 2244002 · Received August 30, 2011

Report

Report Number
1124841-2011-00374
Date Received
August 30, 2011
Date of Event
August 10, 2011
Report Date
August 11, 2011
Manufacturer
TERUMO CARDIOVASCULAR SYSTEMS CORP.
Product Code
GCJ
PMA / PMN Number
K083194
Removal / Correction Number
NA
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
MD, US
Reporter Occupation
OTHER HEALTH CARE PROFESSIONAL

Narratives

Additional Manufacturer Narrative · 1

TERUMO RECEIVED THE ACTUAL DEVICE, AND UPON EVALUATION THE COMPLAINT WAS NOT CONFIRMED; HOWEVER, TERUMO IS STILL INVESTIGATING THIS ISSUE AND WILL BE SUBMITTING A FOLLOW-UP REPORT WHEN MORE INFO BECOMES AVAILABLE. (B)(4).

Description of Event or Problem · 1

THE USER FACILITY REPORTED TO TERUMO CARDIOVASCULAR SYSTEMS THAT DURING VEIN HARVESTING, THERE WAS AN INSUFFLATION PROBLEM WITH THE VIRTUOSAPH ENDOSCOPIC VEIN HARVESTING SYSTEM. THE PRODUCT WAS NOT CHANGED OUT. THERE WAS NO HARM TO PATIENT. THE SURGERY WAS COMPLETED SUCCESSFULLY WITHOUT DELAY.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1 TERUMO VIRTUOSAPH VEIN HARVESTING SYSTEM VIRTUOSAPH DISPOSABLE GCJ TERUMO CARDIOVASCULAR SYSTEMS CORP. MCVS550 14K

Patients

Seq Age Sex Outcome Treatment
1 UNK