BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    RETROGUARD ARTERIAL SAFETY VALVE

    MDR report key: 5439642 · Received February 16, 2016

    Report

    Report Number
    1649914-2016-00003
    Event Type
    Malfunction
    Date Received
    February 16, 2016
    Date of Event
    January 29, 2016
    Report Date
    February 2, 2016
    Manufacturer
    QUEST MEDICAL, INC.
    Product Code
    MJJ
    PMA / PMN Number
    K922356
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    MA, US
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 1

    VISUAL EXAMINATION OF THE DEVICE CONFIRMED THERE WAS A SIGNIFICANT CRACK IN THE HOUSING ON ONE SIDE OF THE DEVICE. IN-PROCESS INSPECTION OF THE DEVICE DURING MANUFACTURE INCLUDES A 100% LEAK TEST. IT IS UNLIKELY THE CRACK OCCURRED AT THE MANUFACTURER'S LOCATION. THIS DEVICE IS SOLD NON-STERILE TO THE DISTRIBUTOR FOR FURTHER PROCESSING (PACKAGING/STERILIZATION) PRIOR TO SHIPMENT TO CUSTOMERS. THE DEVICE HISTORY RECORD FOR THE LOT WAS REVIEWED AND NO DEVICES WERE REJECTED AND NO SPECIFIC MANUFACTURING YIELD ISSUES WERE REPORTED SIMILAR TO THE REPORTED COMPLAINT CONDITION. QUEST MEDICAL, INC. HAS LIMITED INFORMATION RELATED TO THE PATIENT'S MEDICAL HISTORY AND IS UNABLE TO FORM AN OPINION AS TO THE RELEVANCY OF THE PATIENT'S HISTORY TO THE EVENT REPORTED. QUEST MEDICAL, INC. DEFERS TO THE PATIENT'S PHYSICIAN REGARDING MEDICAL HISTORY.

    Description of Event or Problem · 1

    THE DISTRIBUTOR REPORTED AN ISSUE ENCOUNTERED BY THEIR CUSTOMER WITH THE RETROGUARD DEVICE. THIS DEVICE IS SOLD NON-STERILE TO THE DISTRIBUTOR BY THE MANUFACTURE FOR FURTHER PROCESSING (PACKAGING/STERILIZATION). THE REPORT STATED THAT THE ISSUE WAS FOUND AT THE HOSPITAL BY THE PERFUSIONIST WHILE PRIMING THE A-V LOOP. THE PERFUSIONIST REPORTED THAT THE RETROGUARD VALVE LEAKED, AND UPON CLOSER INSPECTION THEY FOUND A CRACK LENGTHWISE ON THE VALVE. THERE WAS NO BLOOD LOSS REPORTED BECAUSE THE ISSUE WAS FOUND DURING PRIMING (NO PATIENT INVOLVEMENT). THE DEVICE WAS RETURNED TO THE DISTRIBUTOR AND THEN TO THE MANUFACTURER FOR EVALUATION.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    96957 RETROGUARD ARTERIAL SAFETY VALVE CPBP ADAPTER, STOPCOCK, MANIFOLD OR FITTING MJJ QUEST MEDICAL, INC. 4007200 048585

    Patients

    Seq Age Sex Outcome Treatment
    1 Required Intervention