FLOW COUPLER 519600001061

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a company representative,health report with the FDA on 2019-12-18 for FLOW COUPLER 519600001061 manufactured by Baxter Healthcare Corporation.

Event Text Entries

[171857731] Should additional relevant information become available, a supplemental report will be submitted.
Patient Sequence No: 1, Text Type: N, H10


[171857732] It was reported that a tearing occurred during anastomosis of two arteries ( ima and the deep inferior epigastric artery (diea)), while using a new coupler system and 2. 5mm coupler ring. It was reported that during the diep flap procedure, the first artery (ima) was coupled successfully whilst the second artery (diea) began tearing when everting. The surgeon had to use an alternative to the coupling system. The patient outcome was not reported. No additional information is available.
Patient Sequence No: 1, Text Type: D, B5


MAUDE Entry Details

Report Number1416980-2019-06989
MDR Report Key9490301
Report SourceCOMPANY REPRESENTATIVE,HEALTH
Date Received2019-12-18
Date of Report2020-01-22
Date of Event2019-11-18
Date Mfgr Received2020-01-17
Date Added to Maude2019-12-18
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 Street25212 W. ILLINOIS ROUTE 120
Manufacturer CityROUND LAKE IL 60073
Manufacturer CountryUS
Manufacturer Postal60073
Manufacturer Phone2242702068
Manufacturer G1SYNOVIS SURGICAL INNOVATIONS
Manufacturer Street2575 UNIVERSITY AVE. W
Manufacturer CitySAINT PAUL MN 55114
Manufacturer CountryUS
Manufacturer Postal Code55114
Single Use3
Previous Use Code3
Event Type3
Type of Report3

Device Details

Brand NameFLOW COUPLER
Generic NameDEVICE, ANASTOMOTIC, MICROVASCULAR
Product CodeMVR
Date Received2019-12-18
Model NumberNA
Catalog Number519600001061
Lot NumberSP19F25-1381499
OperatorHEALTH PROFESSIONAL
Device AvailabilityN
Device AgeDA
Device Eval'ed by MfgrR
Device Sequence No1
Device Event Key0
ManufacturerBAXTER HEALTHCARE CORPORATION
Manufacturer AddressDEERFIELD IL


Patients

Patient NumberTreatmentOutcomeDate
101. Other 2019-12-18

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