MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a company representative,foreig report with the FDA on 2020-03-27 for UNKNOWN N/A manufactured by Datascope Corp. - Mahwah.
[185247673]
The production device history record (dhr) for this intra-aortic balloon pump (iabp) unit was unable to be reviewed as we were not able to obtain the serial number for the iabp associated with this complaint. The device has not been returned to the manufacturer so we are unable to complete an evaluation. If provided we will send a supplemental report with our additional findings. Device not returned.
Patient Sequence No: 1, Text Type: N, H10
[185247674]
Please refer to mfg report number 2248146-2020-00157 for the related intra-aortic balloon catheter. Last april, the (b)(6) received news of an unfortunate event regarding the death of a (b)(6) yo male patient. The patient was being treated for coronary artery stenting following an mi. Shortly into the procedure, following contrast media infusion, guidewire placement and balloon catheter angioplasty, he complained of being unwell (and a? Burning sensation? In his head? ) and rapidly deteriorated on the table and suffered heart failure. It is suggested by the treating cardiologist that the patient experienced a sudden deterioration related to possible anaphylaxis and that this could be have been induced by polyethylene glycol (peg) exposure. The patient had a prior diagnosis of allergy to peg. It is not clear whether the patient suffered a fatal cardiac arrest due to their existing cardiac disorder and treatment, or whether this deterioration was indeed anaphylaxis and directly/indirectly brought on by exposure to peg. The pathologist has not ruled out this possibility. Recently, hm coroner has provided medical records to properly interested persons including (b)(6), and in those medical records is a page on? Equipment barcodes? And details of devices used to treat the patient. One device is listed to be a sensation plus 8 fr, 50cc iab catheter manufactured by getinge.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 2249723-2020-00510 |
| MDR Report Key | 9888846 |
| Report Source | COMPANY REPRESENTATIVE,FOREIG |
| Date Received | 2020-03-27 |
| Date of Report | 2020-03-27 |
| Date of Event | 2019-04-01 |
| Date Mfgr Received | 2020-03-02 |
| Date Added to Maude | 2020-03-27 |
| Event Key | 0 |
| Report Source Code | Manufacturer report |
| Manufacturer Link | Y |
| Number of Patients in Event | 0 |
| Adverse Event Flag | 3 |
| Product Problem Flag | 3 |
| Reprocessed and Reused Flag | 3 |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 3 |
| Event Location | 3 |
| Manufacturer Contact | MS. DOROTA WOLPIUK |
| Manufacturer Street | 1300 MACARTHUR BLVD |
| Manufacturer City | MAHWAH NJ 07430 |
| Manufacturer Country | US |
| Manufacturer Postal | 07430 |
| Manufacturer G1 | DATASCOPE CORP. - MAHWAH |
| Manufacturer Street | 1300 MACARTHUR BLVD |
| Manufacturer City | MAHWAH NJ 07430 |
| Manufacturer Country | US |
| Manufacturer Postal Code | 07430 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | UNKNOWN |
| Generic Name | SYSTEM, BALLOON, INTRA-AORTIC AND CONTROL |
| Product Code | DSP |
| Date Received | 2020-03-27 |
| Model Number | N/A |
| Catalog Number | UNKNOWN |
| Lot Number | N/A |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | N |
| Device Eval'ed by Mfgr | N |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | DATASCOPE CORP. - MAHWAH |
| Manufacturer Address | 1300 MACARTHUR BLVD MAHWAH NJ 07430 US 07430 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Death | 2020-03-27 |