SARNS 8000 PERFUSION SYSTEM 195215

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 2017-05-05 for SARNS 8000 PERFUSION SYSTEM 195215 manufactured by Terumo Cardiovascular Systems Corp..

Event Text Entries

[74669130] (b)(4). Evaluation is in progress, but not yet concluded. As per fsr, the sensor cable disconnect light emitting diode (led) illuminated. The level sensor was attached on the safety monitor. The fsr removed the level sensor and installed a back up level sensor. The unit operated to the manufacturer? S specifications.
Patient Sequence No: 1, Text Type: N, H10


[74669131] The field service representative (fsr) reported that during preventive maintenance (pm) of the device, the alert level sensor tested bad. There was no patient involvement.
Patient Sequence No: 1, Text Type: D, B5


[96508363] The reported complaint was confirmed. During laboratory analysis the product surveillance technician (pst) observed ''level disconnected'' message. Most likely the cause is an internal wiring open circuit, caused by a physical damage. External cable damage was evident within one foot of the sensor-end of the cable. If additional information becomes available on this complaint that would alter the facts and/or conclusion, a supplemental report will be filed accordingly.
Patient Sequence No: 1, Text Type: N, H10


MAUDE Entry Details

Report Number1828100-2017-00222
MDR Report Key6548767
Date Received2017-05-05
Date of Report2017-06-26
Date of Event2017-04-12
Date Mfgr Received2017-06-23
Date Added to Maude2017-05-05
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 FDA3
Event Location3
Manufacturer ContactMS. KATIE HOYT
Manufacturer Street6200 JACKSON ROAD
Manufacturer CityANN ARBOR MI 48103
Manufacturer CountryUS
Manufacturer Postal48103
Single Use3
Previous Use Code3
Event Type3
Type of Report3

Device Details

Brand NameSARNS 8000 PERFUSION SYSTEM
Generic NameMONITOR AND/OR CONTROL, LEVEL SENSING, CARDIOPULMONARY BYPASS-SARNS 8000
Product CodeDTW
Date Received2017-05-05
Returned To Mfg2017-04-24
Model Number195215
Catalog Number195215
Device AvailabilityR
Device AgeDA
Device Eval'ed by MfgrY
Device Sequence No1
Device Event Key0
ManufacturerTERUMO CARDIOVASCULAR SYSTEMS CORP.
Manufacturer Address6200 JACKSON ROAD ANN ARBOR MI 48103 US 48103


Patients

Patient NumberTreatmentOutcomeDate
10 2017-05-05

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