MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 00,01,06,07 report with the FDA on 2014-09-19 for HMS PLUS INSTRUMENT 30514 manufactured by Perfusion Systems.
[21805121]
Medtronic received information reporting that during use of this hms plus in a procedure, the coagulation test results did not meet the user's expectations as blood cots appeared on the pericardium. The user doubted the accuracy of the instrument. Use of the instrument was continued with no resulting adverse patient impact. The instrument was inspected by medtronic france service and remains in use. Additional information has been requested. The details of the event were summarized as follows: o t=0 normal coagulation o bypass lasted 165 min and activated clotting time (act) was between 430 and 460 seconds during that time. Blood clots appeared on the pericardium and the measure of act was 451, another measure of act made with another machine and gave act of 456 sec. O injection of 19000ui of heparin and the end of the procedure
Patient Sequence No: 1, Text Type: D, B5
[22085955]
Event investigation remains in progress and the instrument remains with the customer in the field. However, preliminary analysis performed in the field showed that the device performed as intended. There were no product issues or malfunctions detected that would have impacted this event. Patient and device information has been requested. If additional information is received a supplemental report will be filed. (b)(4).
Patient Sequence No: 1, Text Type: N, H10
[28641601]
This supplemental report is submitted in order to correct the initial report from a reportable serious injury to a non-reportable ev ent. Evaluation of this product event indicates that the device did not cause or contribute to a death or serious injury. Information received from the field indicates that there was no patient harm as a result of this product event. Additionally, evaluation of the device event data showed that the device performed as expected, indicating no malfunction. Additionally, a review of prior events indicates that, for this product or similar product, the product event is not suspected to have been a cause, or contributory cause, of any previous incidents that have led to death or serious injury. Based on the information above, medtronic concluded that this device did not cause or contribute to a death or serious injury and the event would not likely cause or contribute to a death or serious injury if it were to recur. (b)(4).
Patient Sequence No: 1, Text Type: N, H10
[28641602]
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 2184009-2014-00069 |
| MDR Report Key | 4100442 |
| Report Source | 00,01,06,07 |
| Date Received | 2014-09-19 |
| Date of Report | 2014-09-24 |
| Date of Event | 2014-03-28 |
| Date Mfgr Received | 2014-09-24 |
| Date Added to Maude | 2014-09-19 |
| Event Key | 0 |
| Report Source Code | Manufacturer report |
| Manufacturer Link | Y |
| Number of Patients in Event | 0 |
| Adverse Event Flag | 3 |
| Product Problem Flag | 3 |
| Reprocessed and Reused Flag | 3 |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 0 |
| Event Location | 0 |
| Manufacturer Contact | PAULA BIXBY |
| Manufacturer Street | 8200 CORAL SEA STREET NE |
| Manufacturer City | MOUNDS VIEW MN 55112 |
| Manufacturer Country | US |
| Manufacturer Postal | 55112 |
| Manufacturer Phone | 7635055378 |
| Manufacturer G1 | MEDTRONIC STRUCTURAL HEART |
| Manufacturer Street | 8200 CORAL SEA STREET NE |
| Manufacturer City | MOUNDS VIEW MN 55112 |
| Manufacturer Country | US |
| Manufacturer Postal Code | 55112 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | HMS PLUS INSTRUMENT |
| Generic Name | ANALYZER, HEPARIN, AUTOMATED |
| Product Code | JOX |
| Date Received | 2014-09-19 |
| Model Number | 30514 |
| Catalog Number | 30514 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | N |
| Device Age | DA |
| Device Eval'ed by Mfgr | Y |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | PERFUSION SYSTEMS |
| Manufacturer Address | 7611 NORTHLAND DR BROOKLYN PARK MN 55428 US 55428 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Life Threatening | 2014-09-19 |