HMS PLUS INSTRUMENT 30514

MAUDE Adverse Event Report

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.

Event Text Entries

[4761308] 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 when a clot was observed on the heart during a thoracotomy procedure. The user doubted the accuracy of the instrument act (activated clotting time) measurement. 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 injection of 20000 ui heparin o 12min act =559sec o 35 min act=306 sec o injection 10000 ui heparin o 44 min act =356 sec o injection 10000 ui heparin o 55 min act=434 sec o the same day, pericardium effusion leading to thoracotomy showed a clot on the heart. No bleeding evidence with favorable evolution. The customer suggested the problem was the irregularity of the answer to heparin: high answer followed by mild answer to heparin. The instrument had been sent for maintenance just before this procedure.
Patient Sequence No: 1, Text Type: D, B5


[5095049]
Patient Sequence No: 1, Text Type: D, B5


[12214310] This supplemental report is submitted in order to correct the initial report from a reportable serious injury to a non-reportable event. 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


[12284469] 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


MAUDE Entry Details

Report Number2184009-2014-00070
MDR Report Key4100443
Report Source00,01,06,07
Date Received2014-09-19
Date of Report2014-09-24
Date of Event2014-02-20
Date Mfgr Received2014-09-24
Date Added to Maude2014-09-19
Event Key0
Report Source CodeManufacturer report
Manufacturer LinkY
Number of Patients in Event0
Adverse Event Flag3
Product Problem Flag3
Reprocessed and Reused Flag3
Health Professional3
Initial Report to FDA3
Report to FDA0
Event Location0
Manufacturer ContactPAULA BIXBY
Manufacturer Street8200 CORAL SEA STREET NE
Manufacturer CityMOUNDS VIEW MN 55112
Manufacturer CountryUS
Manufacturer Postal55112
Manufacturer Phone7635055378
Manufacturer G1MEDTRONIC STRUCTURAL HEART
Manufacturer Street8200 CORAL SEA STREET NE
Manufacturer CityMOUNDS VIEW MN 55112
Manufacturer CountryUS
Manufacturer Postal Code55112
Single Use3
Previous Use Code3
Event Type3
Type of Report3

Device Details

Brand NameHMS PLUS INSTRUMENT
Generic NameANALYZER, HEPARIN, AUTOMATED
Product CodeJOX
Date Received2014-09-19
Model Number30514
Catalog Number30514
OperatorHEALTH PROFESSIONAL
Device AvailabilityN
Device AgeDA
Device Eval'ed by MfgrY
Device Sequence No1
Device Event Key0
ManufacturerPERFUSION SYSTEMS
Manufacturer Address7611 NORTHLAND DR BROOKLYN PARK MN 55428 US 55428


Patients

Patient NumberTreatmentOutcomeDate
101. Life Threatening 2014-09-19

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