MAUDE MDR 1321068

MDR report key
1321068
Report number
1721752-2009-00001
Event key
0
Event type
3
Date of event
2009-01-22
Date received
2009-02-19
Adverse event
3
Product problem
3
Patients in event
0
Reporter occupation
0
Health professional
3
Initial report to FDA
3
Event location
3

Manufacturer Contact#

Contact
GAIL HAPNER
Address
15715 ARROW HWY IRWINDALE CA 91706 US
Phone
909-909-9098
Report source
M
Manufacturer link flag
Y

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1COOL FLOW IRRIGATION PUMPPUMP, CIRCULATING-FLUID, LOCALIZED HEATHEI INC.,KQTM-5491-02CFP002N N

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12009-02-1901. H; 2. O; 3. R

Event Narratives#

D

Patient 1

IT WAS REPORTED THAT FIFTEEN MINUTES AFTER A TRANSSEPTAL PUNCTURE DURING AN A-FIB PROCEDURE, THE ANESTHESIOLOGIST NOTED A DROP IN THE PT'S BLOOD PRESSURE. AN INTRACARDIAC ECHO WAS USED TO VISUALIZE THE FLUID IN THE PERICARDIUM. A 700CC PERICARDIOCENTESIS OF FLUID REMOVAL FROM THE PERICARDIAL SPACE HAD TO BE PERFORMED. THE CUSTOMER WAS NOT SURE IF THE PERFORATION OCCURRED DURING THE TRANSSEPTAL STEP OR DURING ABLATION (THIS WAS THE FIRST ABLATION). THE PT WAS STABILIZED AND TRANSFERRED TO ICU. THE PT HAD FULLY RECOVERED. THE PROGNOSIS WAS EXCELLENT.

N

Patient 1

INVESTIGATION IS STILL IN PROGRESS. A SUPPLEMENTAL REPORT ON DEVICE EVALUATION WILL BE SUBMITTED ONCE IT IS COMPLETED. (SEE SCANNED PAGE).