FDA Adverse Event Malfunction Summary report: N

VASOVIEW HEMOPRO 2

MDR report key: 3063372 · Received April 11, 2013

Report

Report Number
2242352-2013-00341
Event Type
Malfunction
Date Received
April 11, 2013
Report Date
March 25, 2013
Manufacturer
MAQUET CARDIOVASCULAR, LLC
Product Code
GEI
PMA / PMN Number
K101274
Removal / Correction Number
NA
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
VA, US
Reporter Occupation
PHYSICIAN

Narratives

Additional Manufacturer Narrative · 1

SINCE THE DEVICE IS NOT AVAILABLE TO BE RETURNED TO US, A TECHNICIAN EVALUATION CANNOT BE PERFORMED. PER OUR STANDARD SOP'S, ALL EVENTS ARE TRACKED AND TRENEDED TO DETERMINE WHETHER OR NOT ANY TRENDS DEVELOP. A LOT HISTORY RECORD REVIEW WAS COMPLETED FOR THE REPORTED PRODUCT LOT NUMBER. THERE WAS NO NONCONFORMANCE RECORDED IN THE LOT HISTORY. (B)(4).

Description of Event or Problem · 1

THE HOSPITAL REPORTED THAT NEARING THE END OF AN ENDOSCOPIC VEIN HARVESTING PROCEDURE, THE HEMOPRO 2 DEVICE FAILED TO POWER UP AND RESET. THE HEMOPRO 2, CORD, AND POWER SUPPLY WERE SWITCHED OUT TO COMPLETE THE PROCEDURE. THE HOSPITAL DID NOT REPORT ANY PATIENT EFFECTS. THE HOSPITAL WILL REPORTEDLY NOT BE RETURNING THE PRODUCT IN QUESTION.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
154803 VASOVIEW HEMOPRO 2 ENDOSCOPIC VESSEL HARVESTING GEI MAQUET CARDIOVASCULAR, LLC VH-4000 25066371

Patients

Seq Age Sex Outcome Treatment
1 NA