MAUDE Adverse Event Report: ABBOTT VASCULAR DVI ROTATING HEMOSTATIC VALVE; ACCESSORIES

Catalog Number UNK RHV

Device Problems Break (1069); Leak/Splash (1354); Loose or Intermittent Connection (1371)

Patient Problem Air Embolism (1697)

Event Date 11/18/2022

Event Type  Injury  

Manufacturer Narrative

Date of event: estimated the unique device identifier (udi) is unknown because the part number and lot number were not provided.The device was not returned for analysis.A review of the lot history record and similar incident review of the reported lot could not be conducted because the part and lot number was not provided.Due to the limited information available, the investigation determined a conclusive cause for the reported difficulties cannot be determined.Additionally, a conclusive cause for the reported patient effect, and the relationship to the product, if any, cannot be determined.There is no indication of a product quality issue with respect to manufacture, design or labeling.As multiple devices were captured in the pmcf report.Additional reports were filed under manufacturing reference numbers: (b)(4).Pmcf attachment title: post-market clinical follow-up evaluation report accessories and indeflators.

Event Description

It was reported through a post market clinical follow up (pmcf) evaluation report identifying the rotating hemostatic valve device that may be related to the following: leak, loose/intermittent connection, break, which could potentially lead to air embolism.Details are listed in the attached pmcf, titled post-market clinical follow-up evaluation report accessories and indeflators please see the attached post market clinical follow up evaluation report for specific information.

• Brand Name: DVI ROTATING HEMOSTATIC VALVE
• Type of Device: ACCESSORIES
• Manufacturer (Section D): ABBOTT VASCULAR; 26531 ynez rd.; temecula CA 92591 4628
• Manufacturer (Section G): ABBOTT VASCULAR, REG # 2024168; 26531 ynez road; temecula CA 92591 4628
• Manufacturer Contact: lindsey bell ; 26531 ynez rd.; temecula, CA 92591-4628 ; 9519143996
• MDR Report Key: 16665729
• MDR Text Key: 312542700
• Report Number: 2024168-2023-03379
• Device Sequence Number: 1
• Product Code: DTL
• Combination Product (y/n): N
• Reporter Country Code: BE
• PMA/PMN Number: K854261
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Other
• Reporter Occupation: Other
• Type of Report: Initial
• Report Date: 04/03/2023

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: Yes
• Device Operator: Health Professional
• Device Catalogue Number: UNK RHV
• Was Device Available for Evaluation?: No
• Initial Date Manufacturer Received: 03/10/2023
• Initial Date FDA Received: 04/03/2023
• Was Device Evaluated by Manufacturer?: Device Not Returned to Manufacturer
• Is the Device Single Use?: Yes
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: Initial
• Patient Sequence Number: 1
• Patient Outcome(s): Other