MAUDE Adverse Event Report: INTERVASCULAR SAS HEMAGARD KNITTED AXILLO; PROSTHESIS, VASCULAR GRAFT, OF 6MM AND GREATER DIAMETER

Model Number HGKAX0808

Device Problem Material Deformation (2976)

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

Event Date 07/22/2022

Event Type  Injury  

Event Description

It was reported to intervascular that a hemagard knitted graft appeared to be misshaped.Ill fitted.It was explanted an another graft had to be used.The device not used.The hemagard graft was beveled, and anastomosed to the common femoral and onto the sfa with a running 5-0 prolene suture.At which time they attempted to flush the graft and kept getting resistance.Multiple attempts made to straighten it out but was deemed inadequate and would not hold its shape.The surgery was not delayed because of the event since they had a second one on the shelf ready for use.

Event Description

See mfg initial report.Complaint (b)(4).

Manufacturer Narrative

Corrected data: block d9, h6 code (10) is replaced by code (4115).(4115) it was initially indicated that the device was available to be returned.However, the information was received that the product was discarded by accident by the hospital and thus irretrievably lost for testing.(11/213) a visual inspection has been performed by the qa supervisor on the retention sample.His observations are as follows: "the graft shows no abnormalities, the embossing is regular.It reacts correctly when handled.No non-conformity related to the event described in complaint (b)(4) was observed on this product.It complies with the specifications." (4118/3233) more information is being sought regarding the event.(11) the investigation is still ongoing.A follow-up report will be sent upon completion of the investigation.

Manufacturer Narrative

(4119/213) more details about the event description was requested to the surgeon, unfortunately no relevant information was received.It should be noted that the product reference affected was already ordered by the hospital.(4112/213) the case and its investigation have been reviewed by the medical affairs manager who concluded that based on the limited information provided in this complaint record and without knowing the surgical details regarding the implantation of the intergard (hemagard) vascular graft, it is difficult to ascertain the exact cause of the misshaping of graft or the cause of the resistance during flushing of the graft.(4315) the investigation concluded that no conclusion can be drawn since the product was discarded and the limited information provided.However, the conducted investigation and testing performed suggest that the product was not defective at the time of manufacturing.

Event Description

(b)(4).

• Brand Name: HEMAGARD KNITTED AXILLO
• Type of Device: PROSTHESIS, VASCULAR GRAFT, OF 6MM AND GREATER DIAMETER
• Manufacturer (Section D): INTERVASCULAR SAS; zone industrielle athelia i; la ciotat 13705 ; FR 13705
• Manufacturer (Section G): INTERVASCULAR SAS; zone industrielle athelia i; la ciotat 13705 ; FR 13705
• Manufacturer Contact: laurence richard ; zone industrielle athelia i; la ciotat 13705 ; FR 13705 ; 442084646
• MDR Report Key: 15249595
• MDR Text Key: 298134972
• Report Number: 1640201-2022-00025
• Device Sequence Number: 1
• Product Code: DSY
• UDI-Device Identifier: 00384401015109
• UDI-Public: (01)00384401015109
• Combination Product (y/n): N
• Reporter Country Code: US
• PMA/PMN Number: K964625
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: User Facility
• Reporter Occupation: Non-Healthcare Professional
• Type of Report: Initial,Followup,Followup
• Report Date: 10/24/2022

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 Model Number: HGKAX0808
• Device Catalogue Number: HGKAX0808
• Device Lot Number: 21K14
• Was Device Available for Evaluation?: No
• Initial Date Manufacturer Received: 07/28/2022
• Initial Date FDA Received: 08/18/2022
• Supplement Dates Manufacturer Received: 08/25/2022; 10/05/2022
• Supplement Dates FDA Received: 09/19/2022; 10/24/2022
• Was Device Evaluated by Manufacturer?: No
• Date Device Manufactured: 10/14/2021
• Is the Device Single Use?: Yes
• Type of Device Usage: Initial
• Patient Sequence Number: 1
• Patient Outcome(s): Required Intervention
• Patient Sex: Prefer Not To Disclose