FDA Adverse Event Malfunction Summary report: N

CS100

MDR report key: 8632113 · Received May 22, 2019

Report

Report Number
2249723-2019-00832
Event Type
Malfunction
Date Received
May 22, 2019
Date of Event
April 10, 2018
Report Date
January 30, 2020
Manufacturer
DATASCOPE CORP. - MAHWAH
Product Code
DSP
PMA / PMN Number
K031636
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
AS
Reporter Occupation
OTHER

Narratives

Additional Manufacturer Narrative · 0

THE NATIONAL REPAIR CENTER (NRC) RECEIVED THE FAILED PARTS FOR EVALUATION. A SENIOR REPAIR TECHNICIAN INSTALLED THE IAB DATASETTES INTO TEST FIXTURE. THE DATASSETTES FAILED TESTING , VERIFYING THE REPORTED FAILURE. THE NRC SENT THE DATASETTES TO SUPPLIER FOR FAILURE ANALYSIS. A SUPPLEMENTAL REPORT WILL BE SUBMITTED WHEN THE EVALUATION HAS BEEN COMPLETED.

Additional Manufacturer Narrative · 0

THE SUPPLIER REPORTED THAT THEY VERIFIED THE REPORTED FAILURE. THEY STATED U1 WAS DEFECTIVE AND UNABLE TO REPROGRAM. THE SUPPLIER SCRAPPED THE DEFECTIVE DSS DATASETTE. HOWEVER, THE SUPPLIER RETURNED THE OTHER DATASETTE TO THE NATIONAL REPAIR CENTER (NRC). THE SUPPLIER VERIFIED THE REPORTED FAILURE. THEY REPROGRAMMED U1 AND THE DATASETTE PASSED ALL OF THEIR TESTING. THE NATIONAL REPAIR CENTER INSTALLED THE DATASETTE INTO THE MAIN BOARD OF THE CS100 TEST FIXTURE AND TESTED THE DATASETTE TO FACTORY SPECIFICATIONS PER PROCEDURE, AND CS100 SERVICE MANUAL, AND THE DATASETTE PASSED TESTING. THE DATASETTE WAS SCRAPPED AND RETAINED IN THE NRC PER PROCEDURE.

Additional Manufacturer Narrative · 0

THE GETINGE SERVICE TERRITORY MANAGER (STM) THAT ENCOUNTERED THE ISSUE, REPLACED THE OOB DATASETTES WITH ANOTHER SET OF NEW DATASETTES, AND THEN PERFORMED ALL FUNCTIONAL AND SAFETY CHECKS TO MEET FACTORY SPECIFICATIONS. UNIT PASSED ALL FUNCTIONAL AND SAFETY TEST PER FACTORY SPECIFICATIONS. THE IABP WAS THEN RELEASED TO THE CUSTOMER AND CLEARED FOR CLINICAL SERVICE. THE SUSPECTED FAULTY OOB DATASETTES WILL BE SENT TO GETINGE'S NATIONAL REPAIR CENTER (NRC) FOR EVALUATION. A SUPPLEMENTAL REPORT WILL BE SUBMITTED UPON COMPLETION OF THIS INVESTIGATION. UPDATED FIELDS: B4, G4, G7, H2, H10, AND H11. CORRECTED DATA: B5, D4 (CATALOG#), H10.

Additional Manufacturer Narrative · 0

THE AWARE DATE OF THE INITIAL MDR WAS INCORRECTLY REPORTED. THE INITIAL MDR AWARE DATE SHOULD HAVE READ 04/10/2018 (10-APR-2018). THE PRODUCTION DEVICE HISTORY RECORD (DHR) FOR THIS INTRA-AORTIC BALLOON PUMP (IABP) WAS NOT REQUIRED TO BE REVIEWED AS PER COMPANY STANDARD OPERATING PROCEDURE SINCE THE DEVICE MANUFACTURE DATE IS GREATER THAN ONE YEAR FROM THE EVENT DATE. A GETINGE SERVICE TERRITORY MANAGER (STM) EVALUATED THE IABP AND WAS ABLE TO REPRODUCE THE REPORTED ISSUE. TO RESOLVE THE ISSUE, THE STM REPLACED THE DATASETTES. ALL FUNCTIONAL AND SAFETY TESTS WERE PASSED TO MEET FACTORY SPECIFICATIONS AND THE IABP WAS RETURNED TO THE CUSTOMER AND CLEARED FOR CLINICAL SERVICE. THE INITIAL REPORTER NAMED IS A GETINGE DESIGNEE WHO HAS DIFFERENT CONTACT DETAILS FROM THAT OF THE EVENT SITE; THEIR CONTACT INFORMATION ARE AS FOLLOWS: (B)(6).

Description of Event or Problem · 0

IT WAS REPORTED THAT DURING A FIELD SERVICE CORRECTIVE ACTION (FSCA) RECALL RELATED TO A SOFTWARE UPDATE THAT WAS PERFORMED BY A GETINGE SERVICE TERRITORY MANAGER (STM), THE NEW DATASETTES FOR THE CS100 INTRA-AORTIC BALLOON PUMP (IABP) FAILED TO WORK WHEN INSTALLED. THIS IS AN OUT OF BOX (OOB) FAILURE. THERE WAS NO PATIENT INVOLVEMENT, AND NO ADVERSE EVENT WAS REPORTED.

Description of Event or Problem · 0

IT WAS REPORTED THAT DURING A FIELD SERVICE CORRECTIVE ACTION (FSCA) RECALL RELATED TO A SOFTWARE UPDATE THAT WAS PERFORMED BY A GETINGE SERVICE TERRITORY MANAGER (STM), THE NEW DATASETTES FOR THE CS100 INTRA-AORTIC BALLOON PUMP (IABP) FAILED TO WORK WHEN INSTALLED. THIS IS AN OUT OF BOX (OOB) FAILURE. THERE WAS NO PATIENT INVOLVEMENT, AND NO ADVERSE EVENT WAS REPORTED.

Description of Event or Problem · 0

IT WAS REPORTED THAT DURING A FIELD SERVICE CORRECTIVE ACTION (FSCA) RECALL RELATED TO A SOFTWARE UPDATE THAT WAS PERFORMED BY A GETINGE SERVICE TERRITORY MANAGER (STM), THE NEW DATASETTES FOR THE CS100 INTRA-AORTIC BALLOON PUMP (IABP) FAILED TO WORK WHEN INSTALLED. THIS IS AN OUT OF BOX (OOB) FAILURE. THERE WAS NO PATIENT INVOLVEMENT, AND NO ADVERSE EVENT WAS REPORTED.

Description of Event or Problem · 0

IT WAS REPORTED THAT DURING FIELD SERVICE CORRECTIVE ACTION (FSCA) RECALL, THE DATASETTES FOR THE CS100 INTRA-AORTIC BALLOON PUMP (IABP) FAILED TO WORK OUT OF BOX (OOB) WHEN INSTALLED. THERE WAS NO PATIENT INVOLVEMENT, AND NO ADVERSE EVENT WAS REPORTED.

Additional Manufacturer Narrative · 1

THE PRODUCTION DEVICE HISTORY RECORD (DHR) FOR THIS INTRA-AORTIC BALLOON PUMP (IABP) WAS NOT PERFORMED AS THE SERIAL NUMBER FOR THE UNIT WAS NOT IDENTIFIED. A SUPPLEMENTAL REPORT WILL BE SUBMITTED WHEN SUBSEQUENT INFORMATION IS PROVIDED.

Description of Event or Problem · 1

IT WAS REPORTED THAT DURING FIELD SERVICE CORRECTIVE ACTION (FSCA) RECALL, THE DATASETTES FOR THE CS100 INTRA-AORTIC BALLOON PUMP (IABP) FAILED TO WORK WHEN INSTALLED. THERE WAS NO PATIENT INVOLVEMENT, AND NO ADVERSE EVENT WAS REPORTED.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
426918 CS100 SYSTEM, BALLOON, INTRA-AORTIC AND CONTROL DSP DATASCOPE CORP. - MAHWAH N/A N/A

Patients

Seq Age Sex Outcome Treatment
1