FDA Adverse Event Malfunction Summary report: N

CARDIOSAVE HYBRID TYPE B PLUG

MDR report key: 8806820 · Received July 19, 2019

Report

Report Number
2249723-2019-01130
Event Type
Malfunction
Date Received
July 19, 2019
Report Date
September 12, 2019
Manufacturer
DATASCOPE CORP. - MAHWAH
Product Code
DSP
PMA / PMN Number
K112372
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
HI, US
Reporter Occupation
OTHER

Narratives

Additional Manufacturer Narrative · 0

A GETINGE FIELD SERVICE ENGINEER (FSE) EVALUATED THE IABP UNIT AND WAS ABLE TO REPRODUCE THE REPORTED ISSUE. THE FSE REPLACED THE HI PRESSURE HELIUM REGULATOR AND THE REGULATOR HOUSING BUSHING. THE FSE THEN PERFORMED TESTING AND THE UNIT PASSED ALL CALIBRATIONS, FUNCTIONAL AND SAFETY TEST PER FACTORY SPECIFICATIONS. THE IABP WAS THEN RELEASED TO THE CUSTOMER AND CLEARED FOR CLINICAL SERVICE.

Additional Manufacturer Narrative · 0

UPDATED FIELDS: B4,D4(SERIAL NUMBER),G4,G7,H2,H4, H10, H11. CORRECTED : A1, A3. THE PRODUCTION DEVICE HISTORY RECORD (DHR) FOR THIS INTRA-AORTIC BALLOON PUMP (IABP) IS NOT REQUIRED TO BE REVIEWED PER GETINGE STANDARD OPERATING PROCEDURE SINCE THE IABP WAS MANUFACTURED MORE THAN A YEAR BEFORE THE DATE OF EVENT.

Additional Manufacturer Narrative · 0

A GETINGE FIELD SERVICE ENGINEER (FSE) EVALUATED THE IABP UNIT AND WAS ABLE TO REPRODUCE THE REPORTED ISSUE. THE FSE REPLACED THE HI PRESSURE AND HELIUM REGULATOR. THE FSE THEN PERFORMED TESTING. UNIT PASSED ALL CALIBRATIONS, FUNCTIONAL AND SAFETY TEST PER FACTORY SPECIFICATIONS. THE IABP WAS THEN RELEASED TO THE CUSTOMER AND CLEARED FOR CLINICAL SERVICE.

Description of Event or Problem · 0

IT WAS REPORTED BY THE CUSTOMER THAT WHILE PERFORMING A ROUTINE CHECK OF THE INTRA-AORTIC BALLOON PUMP (IABP) CARDIOSAVE, THE IABP HAD A HELIUM LEAK. THE CUSTOMER STATED A PREVIOUS COMPLAINT WAS MADE AND THE GETINGE FIELD SERVICE ENGINEER (FSE) CAME TO EVALUATE THE UNIT BUT COULD NOT REPRODUCE THE ISSUE AT THE TIME. THERE WAS PATIENT INVOLVEMENT AND NO ADVERSE EVENT WAS REPORTED.

Description of Event or Problem · 0

IT WAS REPORTED BY THE CUSTOMER THAT THE INTRA-AORTIC BALLOON PUMP (IABP) CARDIOSAVE IS LEAKING HELIUM. THE CUSTOMER STATED A PREVIOUS COMPLAINT WAS MADE AND THE GETINGE FIELD SERVICE ENGINEER (FSE) CAME TO EVALUATE THE UNIT BUT COULD NOT REPRODUCE THE ISSUE AT THE TIME. IT IS UNKNOWN THE CIRCUMSTANCE OF THIS EVENT ; IT IS ALSO UNKNOWN IF THERE WAS PATIENT INVOLVEMENT. HOWEVER, NO ADVERSE EVENT WAS REPORTED.

Description of Event or Problem · 0

IT WAS REPORTED BY THE CUSTOMER THAT THE INTRA-AORTIC BALLOON PUMP (IABP) CARDIOSAVE IS LEAKING HELIUM. THE CUSTOMER STATED A PREVIOUS COMPLAINT WAS MADE AND THE GETINGE FIELD SERVICE ENGINEER (FSE) CAME TO EVALUATE THE UNIT BUT COULD NOT REPRODUCE THE ISSUE AT THE TIME. IT IS UNKNOWN THE CIRCUMSTANCE OF THIS EVENT; IT IS ALSO UNKNOWN IF THERE WAS PATIENT INVOLVEMENT. HOWEVER, NO ADVERSE EVENT WAS REPORTED.

Additional Manufacturer Narrative · 1

THE PRODUCTION DEVICE HISTORY RECORD (DHR) FOR THIS INTRA-AORTIC BALLOON PUMP (IABP) UNIT WAS UNABLE TO BE REVIEWED AS WE WERE NOT ABLE TO OBTAIN THE SERIAL NUMBER FOR THE IABP ASSOCIATED WITH THIS COMPLAINT. AT THIS TIME, THE CUSTOMER HAS NOT REQUESTED GETINGE TO EVALUATE THE IABP. ADDITIONAL INFORMATION IS BEING REQUESTED FROM THE CUSTOMER WITH REGARD TO THE REPAIR AND STATUS OF THE IABP. A SUPPLEMENTAL REPORT WILL BE SUBMITTED IF THIS INFORMATION IS PROVIDED TO US.

Description of Event or Problem · 1

IT WAS REPORTED BY THE CUSTOMER THAT THE INTRA-AORTIC BALLOON PUMP (IABP) CARDIOSAVE IS LEAKING HELIUM. THE CUSTOMER STATED A PREVIOUS COMPLAINT WAS MADE AND THE GETINGE FIELD SERVICE ENGINEER (FSE) CAME TO EVALUATE THE UNIT BUT COULD NOT REPRODUCE THE ISSUE AT THE TIME. IT IS UNKNOWN THE CIRCUMSTANCE OF THIS EVENT ; IT IS ALSO UNKNOWN IF THERE WAS PATIENT INVOLVEMENT. HOWEVER, NO ADVERSE EVENT WAS REPORTED.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
602670 CARDIOSAVE HYBRID TYPE B PLUG SYSTEM, BALLOON, INTRA-AORTIC AND CONTROL DSP DATASCOPE CORP. - MAHWAH N/A N/A

Patients

Seq Age Sex Outcome Treatment
1