FDA Adverse Event Malfunction Summary report: N

TERUMO CAPIOX FX 25

MDR report key: 3952483 · Received June 5, 2014

Report

Report Number
MW5037345
Event Type
Malfunction
Date Received
June 5, 2014
Date of Event
April 18, 2014
Report Date
May 7, 2014
Manufacturer
TERUMO CARDIOVASCULAR SYSTEMS
Product Code
DTZ
Product Problem
Yes
Report Source
Voluntary report
Reporter Location
TX, US
Reporter Occupation
RISK MANAGER

Narratives

Description of Event or Problem · 1

THIS IS JUST NOW BEING REPORTED SINCE WE HAVE RULED OUT OTHER POSSIBLE CAUSES TO THE DEVICE NOT WORKING. IN CHECKING THIS DEVICE WE HAVE FOUND THAT THIS IS THE THIRD TIME IN THE PAST YEAR AND A HALF THAT THIS DEVICE HAS LEAKED WHEN SET UP TO USE FOR A SURGERY. THE FIRST TIME IT OCCURRED WAS 1 1/2 YEARS AGO AND NOT THINKING ANYTHING ABOUT IT, THE DEVICE WAS REPLACED AND DISCARDED. SIX MONTHS LATER THE SAME THING HAPPENED WHEN THE DEVICE WAS ATTACHED TO THE MACHINE IT LEAKED AGAIN. IT WAS AT THAT TIME THE PERFUSIONIST NOTIFIED THE COMPANY, SENT THE DEVICE TO THEM ALONG WITH PICTURES. A REPORT WAS SENT BACK TO THE PERFUSIONIST STATING THE CASE WAS FROM A STRESS SUCH AS DROPPING. THE PERFUSIONIST KNOWING THAT IT WAS NOT DROPPED OR ANYTHING DONE WITH IT WENT ON AND FORGOT ABOUT THE ISSUE. NOW ANOTHER SIX MONTHS HAVE PASSED AND THE SAME PROBLEM OCCURRED. THE PERFUSIONIST WAS SETTING UP FOR A HEART SURGERY, HOOKING UP THE MACHINE AND THE DEVICE LEAKED AGAIN. HE CHANGED OUT THE DEVICE AND SET IT ASIDE. WE HAD BIOMED CHECK OUT OUR EQUIPMENT AND EVERYTHING PASSED. LOOKING AT THE DEVICE THAT WAS SET ASIDE AND SAVED WE COMPARED IT TO THE PICTURES FROM THE PREVIOUS EVENT THAT WAS REPORTED. THERE WAS A MOLDING DEFECT NOTICED. THE FOLLOWING IS WHAT IS REPORTED BY THE PERFUSIONIST. THIS IS THE THIRD TIME WE HAVE SEEN THIS. WHAT WE KNOW: ALL ARE WHAT APPEAR TO BE MOLD DEFECTS OR BENDING/MELTING OF THE OUTLET H2O PORT. ALL ARE FX 25. THE PACKAGING FOR THE MOST RECENT OXYGENATOR SHOWS NO SIGN OF DAMAGE OR TEARING. LOT NUMBERS BEGIN WITH 13. ARE IN THE "W" SERIES (DON'T KNOW IF THE "W" MEANS ANYTHING?). WERE MOLDED WITHIN 6 MONTHS OF EACH OTHER. NOTED THAT THE DEFORMITY OCCURS AT THE 3 O'CLOCK POSITIONS WHEN THE GAS INLET PORT IS AT THE BOTTOM (6 O'CLOCK). THE PERFUSIONIST CHECKED THE STOCK SUPPLY AND DID NOT FIND ANY OTHER DEVICES WITH THIS DEFECT. THE OTHER SIMILARITY IS THAT EACH TIME THIS OCCURS IT HAS BEEN 6 MONTHS FROM THE PREVIOUS EVENT. MFR REPORT #: 9681834-2014-00169.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
329484 TERUMO CAPIOX FX 25 OXYGENATOR DTZ TERUMO CARDIOVASCULAR SYSTEMS 131009

Patients

Seq Age Sex Outcome Treatment
1 NA