BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    GUARDIAN II NC HEMOSTASIS VALVE

    MDR report key: 2994429 · Received March 8, 2013

    Report

    Report Number
    3005395947-2013-00006
    Event Type
    Malfunction
    Date Received
    March 8, 2013
    Date of Event
    January 4, 2013
    Report Date
    March 8, 2013
    Manufacturer
    VASCULAR SOLUTIONS ZERUSA LIMITED
    Product Code
    DTL
    PMA / PMN Number
    K122301
    Removal / Correction Number
    3005395947-02/28/2013-01
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    MO, US
    Reporter Occupation
    PHYSICIAN

    Narratives

    Description of Event or Problem · 1

    USER-FACILITY REPORTED PHYSICIANS EXPERIENCING INTRODUCTION OF AIR WHILE USING THE GUARDIAN II NC HEMOSTASIS VALVE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    99715 GUARDIAN II NC HEMOSTASIS VALVE HEMOSTASIS VALVE DTL VASCULAR SOLUTIONS ZERUSA LIMITED 8216 25615

    Patients

    Seq Age Sex Outcome Treatment
    1 Life Threatening