FDA Adverse Event Malfunction Summary report: N

VASOVIEW HEMOPRO 2

MDR report key: 4172430 · Received October 9, 2014

Report

Report Number
2242352-2014-01073
Event Type
Malfunction
Date Received
October 9, 2014
Report Date
September 12, 2014
Manufacturer
MAQUET CARDIOVASCULAR, LLC
Product Code
GEI
PMA / PMN Number
K101274
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
KS, US
Reporter Occupation
OTHER HEALTH CARE PROFESSIONAL

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 EVALUATION IS COMPLETED. A LOT HISTORY RECORD REVIEW WAS COMPLETED FOR THE REPORTED PRODUCT LOT NUMBER. THERE WAS NO NONCONFORMANCE RECORDED IN THE LOT HISTORY. THERE ARE NO OTHER SIMILAR COMPLAINTS REPORTED AGAINST THIS BATCH. (B)(4).

Description of Event or Problem · 1

THE HOSPITAL REPORTED THAT DURING AN ENDOSCOPIC VEIN HARVESTING PROCEDURE, THE VASOVIEW HEMOPRO 2 WAS INSERTED INTO THE LEG AND WOULD NOT ACTIVATE. THEY SWAPPED OUT THE GENERATOR AND CORD TO TROUBLE SHOOT AND STILL DIDN'T WORK. A REPLACEMENT DEVICE WAS USED WITH THE POWER SUPPLY TO COMPLETE THE PROCEDURE. THE HOSPITAL DID NOT REPORT ANY PATIENT EFFECTS. THE PRODUCT IS RETURNING. THE HOSPITAL REPORTED THAT THE EVENT OCCURRED WITHIN THE LAST MONTH.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
636964 VASOVIEW HEMOPRO 2 ENDOSCOPIC VESSEL HARVESTING GEI MAQUET CARDIOVASCULAR, LLC VH-4000 25098675

Patients

Seq Age Sex Outcome Treatment
1