BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    SYNCARDIA CIRCULATORY SUPPORT SYSTEM CONSOLE

    MDR report key: 739518 · Received July 12, 2006

    Report

    Report Number
    3003761017-2006-00016
    Event Type
    Malfunction
    Date Received
    July 12, 2006
    Date of Event
    November 17, 2004
    Report Date
    July 12, 2006
    Manufacturer
    SYNCARDIA SYSTEMS, INC.
    Product Code
    DSQ
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    GM
    Reporter Occupation
    BIOMEDICAL ENGINEER

    Narratives

    Description of Event or Problem · 1

    IN 2006, SYNCARDIA SYSTEMS, INC. BECAME AWARE OF A POSSIBLE MALFUNCTION OF A CSS CONSOLE AS A RESULT OF A REVIEW OF CONSOLE SERVICING RECORDS RECEIVED FROM SYNCARDIA'S SERVICE REP LOCATED IN ANOTHER COUNTRY, WHICH WERE TRANSLATED FROM DIFFERENT LANGUAGE INTO ENGLISH. AN ENTRY DATED 2004 IN THE CONSOLE SERVICING RECORDS FOR CONSOLE STATED "IMBALANCE RIGTH-LEFT." THE ACTIVITY CHART IN THE SERVICING RECORDS FOR THE SAME DATE STATED "CALIBRATION OF VOLUME." FOLLOWING COMPLETION OF THE REPAIR ACTIVITIES, THE SERVICE REP CONDUCTED A SUCCESSFUL CONSOLE CHECKOUT PROCEDURE ON EVENT DAY, AND THE CONSOLE WAS RETURNED TO THE CUSTOMER FOR USE. THE REVIEW OF THE SERVICE RECORDS AND COMPLAINTS FOR THIS CONSOLE INDICATED NO RECURRENCE OF THIS ALLEGED MALFUNCTION. SYNCARDIA HAS BEEN UNABLE TO OBTAIN ANY ADD'L INFO REGARDING THIS EVENT. A REVIEW OF COMPLAINT AND SERVICE RECORDS FROM Q4 2004 THROUGH MAY 2006 DID NOT INDICATE A TREND OR OTHER PATTERN FOR THE REPORTED MALFUNCTION. SYNCARDIA IS CLOSING THIS FILE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 SYNCARDIA CIRCULATORY SUPPORT SYSTEM CONSOLE CIRCULATORY ASSIST DEVICE DSQ SYNCARDIA SYSTEMS, INC. CSS CONSOLE 12590

    Patients

    Seq Age Sex Outcome Treatment
    1 *