FDA Adverse Event Malfunction Summary report: N

VASOVIEW HEMOPRO 2

MDR report key: 4102536 · Received August 27, 2014

Report

Report Number
2242352-2014-00933
Event Type
Malfunction
Date Received
August 27, 2014
Date of Event
August 1, 2014
Report Date
August 1, 2014
Manufacturer
MAQUET CARDIOVASCULAR LLC
Product Code
GEI
PMA / PMN Number
K10274
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
FL, US
Reporter Occupation
PHYSICIAN ASSISTANT

Narratives

Additional Manufacturer Narrative · 1

THE DEVICE HAS BEEN RETURNED TO THE FACTORY AND IS BEING EVALUATED. A SUPPLEMENTAL REPORT WILL BE SUBMITTED WHEN THE EVAL IS COMPLETED. A LOT HISTORY RECORD WAS COMPLETED FOR THE REPORTED PRODUCT LOT NUMBER. THERE WAS NO NONCONFORMITY RECORDED IN THE LOT HISTORY. THERE ARE NO OTHER SIMILAR COMPLAINTS REPORTED AGAINST THIS BATCH. (B)(4).

Description of Event or Problem · 1

THE HOSP REPORTED THAT DURING AN ENDOSCOPIC VEIN HARVESTING PROCEDURE, THE VASOVIEW HEMOPRO 2 STOPPED WORKING. IT DID NOT EMIT ENERGY. NO POWER. THEY TRIED SWITCHING OUT THE POWER CORD AND IT STILL WOULD NOT WORK. A REPLACEMENT DEVICE WAS USED TO COMPLETE THE CASE. THE HOSP DID NOT REPORT ANY PT EFFECTS.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
519091 VASOVIEW HEMOPRO 2 ENDOSCOPIC VESSEL HARVESTING GEI MAQUET CARDIOVASCULAR LLC VH-4000 25098828

Patients

Seq Age Sex Outcome Treatment
1 41 YR