MAUDE Adverse Event Report: MAQUET CARDIOVASCULAR LLC ACCESSRAIL PLATFORM (STANDARD BLADE); INSTRUMENTS, SURGICAL, CARDIOVASCULAR

Model Number SB-1000

Device Problem Mechanical Problem (1384)

Patient Problem No Clinical Signs, Symptoms or Conditions (4582)

Event Date 04/20/2023

Event Type  malfunction  

Event Description

Related to 812290.The hospital reported that the standard left blades were not staying on the ua-5001 retractor, the tabs did not secure the blades.There was no procedural delay.A replacement device was used to complete the procedure.No injuries reported.

Manufacturer Narrative

Trackwise id: (b)(4).The device has been returned to the factory and is being evaluated.A supplemental report will be submitted when the evaluation is completed.

Event Description

N/a.

Manufacturer Narrative

Trackwise#: (b)(4).The device was returned to the factory for evaluation on 04/27/2023.An investigation was conducted on 05/10/2023.A visual inspection was conducted.Signs of clinical use and no evidence of blood was observed.There were no visual defects observed.A mechanical evaluation was conducted.The blades were attached to the retractor with no visual or physical difficulties observed.The blade that was attached to the left side of the retractor would not stay attached.An engineer evaluation was conducted.Please see attached engineer evaluation video.Based on the returned condition of the device as well as the evaluation results, the reported failure "mechanical problem" was confirmed.The lot#: 3000293769 history record review was completed.There were ncmrs , rework, or deviations documented for the reported lot number.Based on results of trf 0017, pn: rm7000992, batch: 3000301371 is entered into this ncmr for proper disposition evaluation.

• Brand Name: ACCESSRAIL PLATFORM (STANDARD BLADE)
• Type of Device: INSTRUMENTS, SURGICAL, CARDIOVASCULAR
• Manufacturer (Section D): MAQUET CARDIOVASCULAR LLC; 45 barbour pond drive; wayne NJ
• Manufacturer (Section G): MAQUET CARDIOVASCULAR LLC; 45 barbour pond drive; wayne NJ
• Manufacturer Contact: arelean guzman ; 45 barbour pond drive; wayne, NJ
• MDR Report Key: 16918132
• MDR Text Key: 315446318
• Report Number: 2242352-2023-00385
• Device Sequence Number: 1
• Product Code: DWS
• UDI-Device Identifier: 00607567700215
• UDI-Public: 00607567700215
• Combination Product (y/n): N
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Health Professional,User Facility,Company Representative
• Reporter Occupation: Other Health Care Professional
• Type of Report: Initial,Followup
• Report Date: 08/03/2023

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 05/12/2023
• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Device Operator: Health Professional
• Device Model Number: SB-1000
• Device Catalogue Number: SB-1000
• Device Lot Number: 3000293769
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 04/27/2023
• Is the Reporter a Health Professional?: Yes
• Date Manufacturer Received: 08/03/2023
• Was Device Evaluated by Manufacturer?: Yes
• Date Device Manufactured: 01/30/2023
• Is the Device Single Use?: Yes
• Type of Device Usage: Initial
• Patient Sequence Number: 1
• Treatment: UNKNOWN.