BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    HEARTWARE® VENTRICULAR ASSIST SYSTEM

    MDR report key: 3842081 · Received May 31, 2014

    Report

    Report Number
    3007042319-2014-00553
    Event Type
    Malfunction
    Date Received
    May 31, 2014
    Date of Event
    October 13, 2013
    Report Date
    May 1, 2014
    Manufacturer
    HEARTWARE, INC
    Product Code
    DSQ
    PMA / PMN Number
    P100047
    Removal / Correction Number
    Z-1607-2014
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    AS
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 1

    PRELIMINARY EVALUATION AND TESTING REVEALED THAT ONE OF THE RETURNED BATTERIES CONTAINED A FAULTY CELL. THIS FINDING WAS RE-ASSESSED PER OUR SOP REQUIREMENTS, AND DETERMINED TO BE REPORTABLE. ADDITIONAL INFORMATION WILL BE SUBMITTED WITHIN THIRTY (30) DAYS OF COMPLETION OF THE INVESTIGATION. THIS IS ONE OF TWO REPORTS (3007042319-2013-00390 AND 3007042319-2014-00553) SUBMITTED FOR DEVICES RELATED TO THE SAME EVENT. EVALUATION IN PROGRESS.

    Additional Manufacturer Narrative · 1

    THE BATTERY WAS RETURNED; VARIOUS ANALYSES WERE CONDUCTED AND REVIEWED IN ORDER TO EVALUATE THE PERFORMANCE OF THE DEVICE IN RELATION TO THE REPORTED EVENT. THOROUGH EXTERNAL VISUAL INSPECTION OF THE BATTERY REVEALED NO SIGNS OF PHYSICAL DAMAGE OR CONTAMINATION. FUNCTIONAL TESTING REVEALED THE RETURNED BATTERY CONTAINED A FAULTY CELL PAIR, WHICH MOST LIKELY CONTRIBUTED TO THE REPORTED EVENT. AN INTERNAL INVESTIGATION (CAPA) HAS BEEN OPENED TO ADDRESS THE ISSUE. THIS IS ONE OF TWO REPORTS (3007042319-2013-00390 AND 3007042319-2014-00553) SUBMITTED FOR DEVICES RELATED TO THE SAME EVENT.

    Description of Event or Problem · 1

    APPROXIMATELY FIVE MONTHS POST HVAD IMPLANT, THE PATIENT EXPERIENCED A SHORT, HIGH PRIORITY ALARM WITH ONE FULLY CHARGED BATTERY ON ONE PORT, AND AC POWER CONNECTED TO THE OTHER PORT. IT WAS NOTED THAT NO MESSAGE APPEARED ON THE SCREEN AT THE TIME OF THE HIGH PRIORITY ALARM. THE PATIENT MANUALLY MANIPULATED THE CONNECTION, AND THE POWER RETURNED. THE CONTROLLER AND BATTERIES WERE REMOVED FROM THE PATIENT AND NEW ONES WERE SUPPLIED. NO HARM OR INJURY TO THE PATIENT WAS REPORTED AS A RESULT OF THIS INCIDENT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    320383 HEARTWARE® VENTRICULAR ASSIST SYSTEM CIRCULATORY ASSIST SYSTEM, BATTERY DSQ HEARTWARE, INC

    Patients

    Seq Age Sex Outcome Treatment
    1 (B)(4) - BATTERY| (B)(4) - BATTERY| (B)(4) - CAC ADAPTER| (B)(4) - CAC ADAPTER| (B)(4) - CONTROLLER| (B)(4) - BATTERY