MAUDE Adverse Event Report: MAQUET CARDIOPULMONARY AG VASCULAR ACCESS KIT; DUAL LUMEN CANNULA

Device Problem Difficult to Remove (1528)

Patient Problems Death (1802); Heart Failure (2206)

Event Type  Death  

Event Description

Ref # imp (b)(4).

Manufacturer Narrative

(b)(4).Maquet (b)(4) provides product failure investigation, analysis and resolution for the device described in this report.The device is not available for return.A supplemental medwatch will be submitted if additional information becomes available.(b)(4).

• Brand Name: VASCULAR ACCESS KIT
• Type of Device: DUAL LUMEN CANNULA
• Manufacturer (Section D): MAQUET CARDIOPULMONARY AG; rastatt ; GM
• Manufacturer (Section G): MAQUET CARDIOPULMONARY AG; kehler strasse 31; rastatt 7643 7; GM 76437
• Manufacturer Contact: janice pevide ; 45 barbour pond drive; wayne, NJ 07470 ; 9737097753
• MDR Report Key: 3598971
• MDR Text Key: 4192189
• Report Number: 8010762-2014-00030
• Device Sequence Number: 1
• Product Code: DWF
• Combination Product (y/n): N
• PMA/PMN Number: K081820
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Health Professional,User Facility,Company Representative
• Type of Report: Initial

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: No
• Device Operator: Other
• Initial Date Manufacturer Received: 12/27/2013
• Initial Date FDA Received: 01/24/2014
• Was Device Evaluated by Manufacturer?: Device Not Returned to Manufacturer
• Date Device Manufactured: 04/01/2013
• Is the Device Single Use?: Yes
• Type of Device Usage: Initial
• Patient Sequence Number: 1