FDA Adverse Event Malfunction Summary report: N

CARDIOQUIP MODULAR COOLER HEATER

MDR report key: 6944361 · Received October 12, 2017

Report

Report Number
3007899424-2017-00002
Event Type
Malfunction
Date Received
October 12, 2017
Date of Event
January 20, 2016
Report Date
June 30, 2022
Manufacturer
CARDIOQUIP, LLC
Product Code
DWC
PMA / PMN Number
K102147
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
NC, US
Reporter Occupation
BIOMEDICAL ENGINEER
Health Professional
Yes

Narratives

Additional Manufacturer Narrative · 0

THE MANUFACTURER IS REPORTING THE FOLLOWING COMPLAINT AFTER A VOLUNTARY REVIEW OF ALL COMPLAINTS (REPORTABLE OR NOT) SINCE 2016. THIS REPORT IS BEING FILED NOW, AFTER BEING SCRUTINIZED UNDER A NEWLY REVISED RISK MATRIX, RECENTLY ADOPTED AFTER INSPECTION. THE UNIT WAS STILL UNDER WARRANTY AND A REPLACEMENT UNIT WAS SENT TO THE CUSTOMER. CARDIOQUIP SERVICE RECEIVED THE DEVICE AND INSPECTED THE UNIT. THE ONLY COMPONENT THAT WAS NONFUNCTIONING WAS THE SCREEN. THE SCREEN WAS REPAIRED, A FINAL INSPECTION WAS PERFORMED, AND PASSED FOR FULL FUNCTIONALITY.

Additional Manufacturer Narrative · 0

THE MANUFACTURER IS REPORTING THE FOLLOWING COMPLAINT AFTER A VOLUNTARY REVIEW OF ALL COMPLAINTS (REPORTABLE OR NOT) SINCE 2016. THIS REPORT IS BEING FILED NOW, AFTER BEING SCRUTINIZED UNDER A NEWLY REVISED RISK MATRIX, RECENTLY ADOPTED AFTER INSPECTION. THE UNIT WAS STILL UNDER WARRANTY AND A REPLACEMENT UNIT WAS SENT TO THE CUSTOMER. CARDIOQUIP SERVICE RECEIVED THE DEVICE AND INSPECTED THE UNIT. THE ONLY COMPONENT THAT WAS NONFUNCTIONING WAS THE SCREEN. THE SCREEN WAS REPAIRED, A FINAL INSPECTION WAS PERFORMED, AND PASSED FOR FULL FUNCTIONALITY.

Description of Event or Problem · 0

CUSTOMER REPORTS THE UNIT WAS NOT WORKING PROPERLY, AND THE NURSE NOTED A "SMELL OF SMOKE."

Description of Event or Problem · 0

CUSTOMER REPORTS THE UNIT WAS NOT WORKING PROPERLY, AND THE NURSE NOTED A "SMELL OF SMOKE."

Additional Manufacturer Narrative · 1

THIS REPORT IS BEING SUBMITTED TO REPLACE REPORT NUMBER MW5068335, SUBMITTED ON 03/06/2017.

Additional Manufacturer Narrative · 1

THIS REPORT IS BEING SUBMITTED TO REPLACE REPORT NUMBER MW5068335, SUBMITTED ON 03/06/2017.

Description of Event or Problem · 1

THE CUSTOMER HAD CALLED REPORTING THE UNIT WAS NOT WORKING PROPERLY, AND THAT THE NURSE NOTED A "SMELL OF SMOKE". THE CUSTOMER WAS SENT A NEW UNIT, THE UNIT IN QUESTION WAS INVESTIGATED AND WAS FOUND TO HAVE SHIPPING DAMAGE. UPON FURTHER INSPECTION OF THE UNIT, THE MANUFACTURER WAS UNABLE TO PRODUCE EITHER THE SMELL OR THE APPEARANCE OF SMOKE FROM THE UNIT.

Description of Event or Problem · 1

THE CUSTOMER HAD CALLED REPORTING THE UNIT WAS NOT WORKING PROPERLY, AND THAT THE NURSE NOTED A "SMELL OF SMOKE". THE CUSTOMER WAS SENT A NEW UNIT, THE UNIT IN QUESTION WAS INVESTIGATED AND WAS FOUND TO HAVE SHIPPING DAMAGE. UPON FURTHER INSPECTION OF THE UNIT, THE MANUFACTURER WAS UNABLE TO PRODUCE EITHER THE SMELL OR THE APPEARANCE OF SMOKE FROM THE UNIT.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
722850 CARDIOQUIP MODULAR COOLER HEATER CARDIOPULMONARY BYPASS DEVICE DWC CARDIOQUIP, LLC MCH-1000(M)

Patients

Seq Age Sex Outcome Treatment
1 Unknown