BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    GUARDIAN II HEMOSTASIS VALVE

    MDR report key: 2994811 · Received March 8, 2013

    Report

    Report Number
    3005395947-2013-00002
    Event Type
    Malfunction
    Date Received
    March 8, 2013
    Date of Event
    February 14, 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
    TX, US
    Reporter Occupation
    PHYSICIAN

    Narratives

    Description of Event or Problem · 1

    DURING A CLINICAL PROCEDURE, THE PHYSICIAN NOTED AIR WAS DRAWN INTO THE LINE DURING ASPIRATION.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    100134 GUARDIAN II HEMOSTASIS VALVE HEMOSTASIS VALVE DTL VASCULAR SOLUTIONS ZERUSA LIMITED 8210 30238

    Patients

    Seq Age Sex Outcome Treatment
    1 Life Threatening