CARDIOMEMS ENDOSURE DELIVERY SYSTEM * ADS-1001

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 07 report with the FDA on 2007-03-12 for CARDIOMEMS ENDOSURE DELIVERY SYSTEM * ADS-1001 manufactured by Cardiomems.

Event Text Entries

[20618682] Patient had tortuous iliacs bilaterally. When sensor delivery system was inserted, physician met resistance. Upon removal, it was found that the dilator tip detached from the catheter body. A snare was used to retrieve the tip. Patient did not suffer any subsequent injury.
Patient Sequence No: 1, Text Type: D, B5


MAUDE Entry Details

Report Number3004936110-2007-00002
MDR Report Key827939
Report Source07
Date Received2007-03-12
Date of Report2007-03-12
Date of Event2007-01-10
Date Mfgr Received2007-01-10
Date Added to Maude2007-03-16
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 Location0
Manufacturer Street75 FIFTH ST., N.W. STE., 440
Manufacturer CityATLANTA GA 30308
Manufacturer CountryUS
Manufacturer Postal30308
Manufacturer Phone4049206712
Manufacturer G1*
Manufacturer Street*
Manufacturer City*
Manufacturer Country*
Single Use3
Previous Use Code3
Event Type3
Type of Report3

Device Details

Brand NameCARDIOMEMS ENDOSURE DELIVERY SYSTEM
Generic NameINTRAVASCULAR PRESSURE SENSOR
Product CodeNQH
Date Received2007-03-12
Returned To Mfg2007-02-09
Model Number*
Catalog NumberADS-1001
Lot Number*
ID Number*
OperatorHEALTH PROFESSIONAL
Device AvailabilityY
Device Eval'ed by MfgrY
Implant FlagY
Date Removed*
Device Sequence No1
Device Event Key815344
ManufacturerCARDIOMEMS
Manufacturer Address* ATLANTA GA * US
Baseline Brand NameENDOSURE AAA PRESSURE SENSOR/DELIVERY SYSTEM
Baseline Generic NameINTRASAC PRESSURE SENSOR/DELIVERY CATHETER
Baseline Model NoNA
Baseline Catalog NoADS-1001
Baseline IDNA


Patients

Patient NumberTreatmentOutcomeDate
101. Required No Informationntervention 2007-03-12

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