MAUDE MDR 7695363

MDR report key
7695363
Report number
2020394-2018-01222
Event key
0
Event type
3
Date of event
2018-06-15
Date received
2018-07-17
Adverse event
3
Product problem
3
Patients in event
0
Reporter occupation
1
Health professional
3
Initial report to FDA
3
Event location
3

Manufacturer Contact#

Contact
JUDITH LUDWIG
Address
1625 W 3RD ST. TEMPE AZ 85281 US
Phone
480-480-4803
Report source
M
Manufacturer link flag
Y

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1DISTAFLO EPTFE VASCULAR GRAFTEPTFE VASCULAR GRAFTBARD PERIPHERAL VASCULAR, INC.DYFDFM6006SCDFM6006SCVTBW0640R N

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12018-07-170

Event Narratives#

N

Patient 1

AS THE LOT NUMBER FOR THE DEVICE WAS PROVIDED, A MANUFACTURING REVIEW WAS PERFORMED. THE SAMPLE WAS NOT RETURNED TO THE MANUFACTURER FOR INSPECTION/EVALUATION. THEREFORE, THE INVESTIGATION OF THE REPORTED EVENT IS INCONCLUSIVE. BASED UPON THE AVAILABLE INFORMATION, THE DEFINITIVE ROOT CAUSE FOR THIS EVENT IS UNKNOWN. THE INSTRUCTION FOR USE (IFU) IS ADEQUATE FOR THE REPORTED DEVICE/PATIENT AND PROVIDES GENERAL INSTRUCTIONS FOR USE, AS WELL AS WARNINGS, PRECAUTIONS AND POTENTIAL COMPLICATIONS ASSOCIATED WITH THE DEVICE. UPON RECEIPT OF NEW OR ADDITIONAL INFORMATION, A FOLLOW-UP REPORT WILL BE SUBMITTED AS APPLICABLE. THE INFORMATION PROVIDED BY BARD REPRESENTS ALL OF THE KNOWN INFORMATION AT THIS TIME. DESPITE GOOD FAITH EFFORTS TO OBTAIN ADDITIONAL INFORMATION, THE COMPLAINANT / REPORTER WAS UNABLE OR UNWILLING TO PROVIDE ANY FURTHER PATIENT, PRODUCT, OR PROCEDURAL DETAILS TO BARD.

D

Patient 1

IT WAS REPORTED THAT DURING PLACEMENT OF A VASCULAR GRAFT FOR A BYPASS PROCEDURE, THE GRAFT WAS ALLEGEDLY TORE UPON REMOVAL OF THE SPIRAL BEADING. IT WAS FURTHER REPORTED THAT THE HEALTH CARE PROVIDER MADE REVISIONS TO THE GRAFT AND COMPLETED THE PROCEDURE. THERE WAS NO REPORTED PATIENT INJURY.