BEUDAMED
    FDA Adverse Event Other Summary report: N

    SYMMETRY BYPASS DEVICE

    MDR report key: 548324 · Received July 14, 2004

    Report

    Report Number
    MW1032687
    Event Type
    Other
    Date Received
    July 14, 2004
    Date of Event
    March 3, 2004
    Report Date
    June 8, 2004
    Manufacturer
    *
    Product Code
    FZP
    Adverse Event
    Yes
    Report Source
    Voluntary report
    Reporter Location
    NM, US
    Reporter Occupation
    NO INFORMATION

    Narratives

    Description of Event or Problem · 1

    ELEVEN MOS AFTER THE SYMMETRY BYPASS CONNECTOR (SBC) WAS IMPLANTED CARDIAC CATHETERIZATION REVEALED 100% RE-OCCLUSION OF THE DISTAL PORTION OF THE RIGHT CORONARY ARTERY (RCA). THE SBC WAS USED AT THIS LOCATION WITH A SAPHENOUS VEIN GRAFT (SVG).

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 SYMMETRY BYPASS DEVICE GRAFT DEVICE FZP * * *

    Patients

    Seq Age Sex Outcome Treatment
    1 74 YR Other