BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    HEARTWARE VENTRICULAR ASSIST SYSTEM-CONTROLLER

    MDR report key: 7039389 · Received November 16, 2017

    Report

    Report Number
    3007042319-2017-04068
    Event Type
    Malfunction
    Date Received
    November 16, 2017
    Date of Event
    October 5, 2017
    Report Date
    March 16, 2018
    Manufacturer
    HEARTWARE, INC.
    Product Code
    DSQ
    UDI-DI
    00888707000420
    PMA / PMN Number
    P100047
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    GM
    Reporter Occupation
    HEALTH PROFESSIONAL

    Narratives

    Additional Manufacturer Narrative · 0

    PRODUCT EVENT SUMMARY: THE CONTROLLER AND SIX BATTERIES WERE RETURNED FOR EVALUATION. VARIOUS ANALYSES WERE CONDUCTED AND REVIEWED IN ORDER TO EVALUATE THE PERFORMANCE OF THE DEVICES IN RELATION TO THE REPORTED EVENT. FAILURE ANALYSIS OF THE RETURNED CONTROLLER AND BATTERIES REVEALED THAT THE DEVICES PASSED VISUAL EXAMINATION AND FUNCTIONAL TESTING. AN ATTEMPT WAS MADE TO REPLICATE THE ISSUE BY MANIPULATING THE BATTERIES' CONNECTION TO A CONTROLLER DURING THE ANALYSIS OF THE UNIT. RESULTS REVEALED THAT THE ELECTRICAL CONNECTION BETWEEN THE BATTERIES AND THE CONTROLLER WAS STABLE. ANALYSIS OF THE DATA LOG FILES FROM THE RETURNED CONTROLLER, CON304413, REVEALED SEVERAL PREMATURE POWER SWITCHING EVENTS THAT WERE DUE TO MOMENTARY DISCONNECTIONS INVOLVING BAT219745, BAT219901, BAT219938, BAT219960, BAT220602 AND BAT220814. THE MOST LIKELY ROOT CAUSE OF THE REPORTED EVENT CAN BE ATTRIBUTED TO MOMENTARY DISCONNECTIONS BETWEEN THE CONTROLLER AND BATTERIES. AN INTERNAL INVESTIGATION WAS OPENED TO EVALUATE MOMENTARY DISCONNECTION. ADDITIONAL PRODUCTS: 1650DE/ BAT220602 D10: RETURN DATE: 2017-11-13 H3: YES H6 FDA METHOD CODE(S): 10, 23, 38, 3372 H6 FDA RESULTS CODE(S): 3213 H6 FDA CONCLUSION CODE(S): 25 ADDITIONAL PRODUCTS: 1650DE/ BAT219938 D10: RETURN DATE: 2017-11-13 H3: YES H6 FDA METHOD CODE(S): 10, 23, 38, 3372 H6 FDA RESULTS CODE(S): 3213 H6 FDA CONCLUSION CODE(S): 25 ADDITIONAL PRODUCTS: 1650DE/ BAT219960 D10: RETURN DATE: 2017-11-13 H3: YES H6 FDA METHOD CODE(S): 10, 23, 38, 3372 H6 FDA RESULTS CODE(S): 3213 H6 FDA CONCLUSION CODE(S): 25 ADDITIONAL PRODUCTS: 1650DE/ BAT220814 D10: RETURN DATE: 2017-11-13 H3: YES H6 FDA METHOD CODE(S): 10, 23, 38, 3372 H6 FDA RESULTS CODE(S): 3213 H6 FDA CONCLUSION CODE(S): 25 ADDITIONAL PRODUCTS: 1650DE/ BAT219901 D10: RETURN DATE: 2017-11-13 H3: YES H6 FDA METHOD CODE(S): 10, 23, 38, 3372 H6 FDA RESULTS CODE(S): 3213 H6 FDA CONCLUSION CODE(S): 25 ADDITIONAL PRODUCTS: 1650DE/ BAT219745 D10: RETURN DATE: 2017-11-13 H3: YES H6 FDA METHOD CODE(S): 10, 23, 38, 3372 H6 FDA RESULTS CODE(S): 3213 H6 FDA CONCLUSION CODE(S): 25 MEDTRONIC, INC. (MEDTRONIC) IS SUBMITTING THIS REPORT TO COMPLY WITH 21 C.F.R. PART 803, THE MEDICAL DEVICE REPORTING REGULATION. THIS REPORT IS BASED UPON INFORMATION OBTAINED BY MEDTRONIC, WHICH THE COMPANY MAY NOT HAVE BEEN ABLE TO FULLY INVESTIGATE OR VERIFY PRIOR TO THE DATE THE REPORT WAS REQUIRED BY THE FDA. MEDTRONIC HAS MADE REASONABLE EFFORTS TO OBTAIN MORE COMPLETE INFORMATION IN THE TIME ALLOTTED AND HAS PROVIDED AS MUCH INFORMATION AS IS AVAILABLE TO THE COMPANY AS OF THE SUBMISSION DATE THIS REPORT. THIS REPORT DOES NOT CONSTITUTE AN ADMISSION OR A CONCLUSION BY FDA, MEDTRONIC, OR ITS EMPLOYEES THAT THE DEVICE, MEDTRONIC OR ITS EMPLOYEES CAUSED OR CONTRIBUTED TO THE EVENT DESCRIBED IN THE REPORT. IN PARTICULAR, THIS REPORT DOES NOT CONSTITUTE AN ADMISSION BY ANYONE THAT THE PRODUCT DESCRIBED IN THIS REPORT HAS ANY "DEFECTS" OR HAS "MALFUNCTIONED". THESE WORDS ARE INCLUDED IN THE FDA 3500A FORM AND ARE FIXED ITEMS FOR SELECTION CREATED BY THE FDA, TO CATEGORIZE THE TYPE OF EVENT SOLELY FOR THE PURPOSE OF REPORTING PURSUANT TO PART 803. MEDTRONIC OBJECTS TO THE USE OF THESE WORDS AND OTHERS LIKE IT BECAUSE OF THE LACK OF DEFINITION AND THE CONNOTATIONS IMPLIED BY THESE TERMS. THIS STATEMENT SHOULD BE INCLUDED WITH ANY INFORMATION OR REPORT DISCLOSED TO THE PUBLIC UNDER THE FREEDOM OF INFORMATION ACT. ANY REQUIRED FIELDS THAT ARE UNPOPULATED ARE BLANK BECAUSE THE INFORMATION IS CURRENTLY UNKNOWN OR UNAVAILABLE. A GOOD FAITH EFFORT WILL BE MADE TO OBTAIN THE APPLICABLE INFORMATION RELEVANT TO THE REPORT. IF INFORMATION IS PROVIDED IN THE FUTURE, A SUPPLEMENTAL REPORT WILL BE ISSUED.

    Additional Manufacturer Narrative · 1

    THIS DEVICE IS USED FOR TREATMENT NOT DIAGNOSIS. THE VENTRICULAR ASSIST SYSTEM IS INDICATED FOR USE AS A BRIDGE TO CARDIAC TRANSPLANTATION AND DESTINATION THERAPY IN PATIENTS WHO ARE AT RISK OF DEATH FROM REFRACTORY END-STAGE LEFT VENTRICULAR HEART FAILURE. THE SYSTEM IS DESIGNED FOR IN-HOSPITAL AND OUT-OF-HOSPITAL SETTINGS. BATTERY/ (B)(4) / CAT#1650DE / EXP. DATE: 07/31/2017. (B)(4). DEVICE AVAILABLE FOR EVALUATION: YES. DEVICE EVALUATED BY MANUFACTURER: NO. DEVICE EVALUATION ANTICIPATED, BUT NOT YET BEGUN MFG. DATE: 08/01/2016. LABELED FOR SINGLE USE: NO. (B)(4). BATTERY/ (B)(4) / CAT#1650DE / EXP. DATE: 06/30/2017. (B)(4). DEVICE AVAILABLE FOR EVALUATION: YES. DEVICE EVALUATED BY MANUFACTURER: NO. DEVICE EVALUATION ANTICIPATED, BUT NOT YET BEGUN. MFG. DATE: 07/01/2016. LABELED FOR SINGLE USE: NO. (B)(4). BATTERY/ (B)(4) / CAT#1650DE / EXP. DATE: 06/30/2017. (B)(4). DEVICE AVAILABLE FOR EVALUATION: YES. DEVICE EVALUATED BY MANUFACTURER: NO. DEVICE EVALUATION ANTICIPATED, BUT NOT YET BEGUN. MFG. DATE: 07/01/2016. LABELED FOR SINGLE USE: NO. (B)(4). BATTERY/ (B)(4) / CAT#1650DE / EXP. DATE: 07/31/2017. (B)(4). DEVICE AVAILABLE FOR EVALUATION: YES. DEVICE EVALUATED BY MANUFACTURER: NO. DEVICE EVALUATION ANTICIPATED, BUT NOT YET BEGUN. MFG. DATE: 08/01/2016. LABELED FOR SINGLE USE: NO. (B)(4). BATTERY/ (B)(4) / CAT#1650DE / EXP. DATE: 06/30/2017. (B)(4). DEVICE AVAILABLE FOR EVALUATION: YES. DEVICE EVALUATED BY MANUFACTURER: NO. DEVICE EVALUATION ANTICIPATED, BUT NOT YET BEGUN. MFG. DATE: 07/01/2016. LABELED FOR SINGLE USE: NO. (B)(4). BATTERY/ (B)(4)/ CAT#1650DE / EXP. DATE: 06/30/2017. (B)(4). DEVICE AVAILABLE FOR EVALUATION: YES. DEVICE EVALUATED BY MANUFACTURER: NO. DEVICE EVALUATION ANTICIPATED, BUT NOT YET BEGUN. MFG. DATE: 07/01/2016. LABELED FOR SINGLE USE: NO. (B)(4). IF INFORMATION IS PROVIDED IN THE FUTURE, A SUPPLEMENTAL REPORT WILL BE ISSUED.

    Description of Event or Problem · 1

    IT WAS REPORTED THAT THERE WERE SEVERAL BATTERY SWITCHING EVENTS. ALL OF THE PATIENT'S BATTERIES AND THE CONTROLLER WERE REPLACED. THE VENTRICULAR ASSIST DEVICE (VAD) REMAINS IN USE. NO PATIENT COMPLICATIONS HAVE BEEN REPORTED AS A RESULT OF THIS EVENT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    817327 HEARTWARE VENTRICULAR ASSIST SYSTEM-CONTROLLER VENTRICULAR (ASSISST) BYPASS DSQ HEARTWARE, INC. 1420-MCS 00888707000420

    Patients

    Seq Age Sex Outcome Treatment
    1 UNKNOWN MCS VAD