MAUDE MDR 4921005

MDR report key
4921005
Report number
2248721-2015-00050
Event key
0
Event type
3
Date of event
2015-06-10
Date received
2015-07-15
Adverse event
3
Product problem
3
Patients in event
0
Reporter occupation
100
Health professional
3
Initial report to FDA
3
Event location
3

Manufacturer Contact#

Contact
JON MCDERMED
Address
8 OLSEN AVE. EDISON NJ 08820 US
Phone
858-858-8582
Report source
M
Manufacturer link flag
Y

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1HEMOCHRON JR. MICROCOAGULATION ACT PLUS TESTINTERNATIONAL TECHNIDYNE CORP.JBPJACT+JACT+C5JAC817R N

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12015-07-150

Event Narratives#

D

Patient 1

HEALTHCARE PROFESSIONAL REPORTED OUT OF RANGE HIGH READINGS WITH HEMOCHRON SIGNAURE ELITE AND ACT PLUS SYSTEM. A (B)(6) MALE PATIENT WAS RECEIVING IV HEPARIN WHILE ON CARDIVASCULAR BYPASS DURING AN AORTIC VALVE REPAIR PROCEDURE. THE TARGET ACT WAS 440-480 SECONDS. THE HEMOCHRON SIGNATURE ELITE AND ACT PLUS SYSTEM REPORTED TWO CONSECUTIVE ACT RESULTS THAT WERE OUT OF RANGE HIGH (>1005 SECONDS). TIMES OF ADMINISRATION AND DOSAGE OF HEPARIN WERE NOT SPECIFIED. THE CASE CONTINUED AND A SUBSEQUENT ACT MEASURED WITH THE SME HEMOCHRON SIGNAURE ELITE AND ACT PLUS SYSTEM WAS 379 SECONDS, WHICH WAS BELOW THE TARGET ACT RANGE. BOTH ELECTRONIC AND LIQUID QUALITY CONTROLS PASSED. THE PROCEDURE WAS AS FOCOMPLETED SUCESSFULLY AND NO PATIENT INJURY OR ADVERSE EVENTS WERE REPORTED.

N

Patient 1

(B)(4). THE SERIAL NUMBER OF THE HEMOCHRON SIGNATURE ELITE INSTRUMENT USED DURING THIS PROCEDURE IS (B)(4). ASSESSMENT OF (B)(4) CONCLUDED THAT IT WAS UNRELATED TO THE COMPLAINT. NO OTHER NCRS OR OTHER ANOMALIES RELATED TO THE COMPLAINT WERE IDENTIFIED. NO CURRENT LOT OR PRODUCT TRENDS. NO CAPA. DESPITE MULTIPLE REQUESTS BY ITC FOR THE HEPARIN DOSES AND TIMING OF DRUG ADMINISTRATION, THE END USER HAS REFUSED TO PROVIDE THE REQUESTED INFORMATION. ITC WILL CONTINUE FOLLOWING THIS COMPLAINT AND WILL REPORT A FOLLOW-UP MDR IF THIS INFORMATION BECOMES AVAILABLE. ITC HAS REQUESTED ALL DATA REQUIRED FOR FORM 3500A.

D

Patient 1

FOLLOW-UP #1.