BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    CS100

    MDR report key: 4213129 · Received August 4, 2014

    Report

    Report Number
    2249723-2014-01139
    Event Type
    Malfunction
    Date Received
    August 4, 2014
    Date of Event
    December 12, 2011
    Report Date
    December 13, 2011
    Manufacturer
    DATASCOPE CORP.,
    Product Code
    DSP
    PMA / PMN Number
    K031636
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CA, US
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 1

    THE COMPANY REP WAS UNABLE TO DUPLICATE THE REPORTED PROBLEM. THE REPORTED EVENT OF AUTOFILL FAILURE ALARM WAS VERIFIED IN THE ALARM LOOP. THE COMPANY REP PERFORMED PERFORMANCE SERVICE DIAGNOSTICS, FUNCTIONAL TESTS AND ELECTRICAL SAFETY TESTS. THE UNIT MET FACTORY SPECS AND WAS RETURNED TO THE CUSTOMER. (B)(4).

    Description of Event or Problem · 1

    THE CUSTOMER REPORTED THAT WHILE THE UNIT WAS IN USE ON A PT, THE UNIT GENERATED AN AUTOFILL FAILURE ALARM. THE PT WAS SWITCHED TO ANOTHER UNIT AND THERAPY WAS CONTINUED. NO PT INJURY WAS REPORTED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    455654 CS100 INTRA-AORTIC BALLOON PUMP DSP DATASCOPE CORP., CS100

    Patients

    Seq Age Sex Outcome Treatment
    1