MAUDE Adverse Event Report: SORIN GROUP DEUTSCHLAND GMBH S5 ROLLER PUMP; CONSOLE, HEART-LUNG MACHINE, CARDIOPULMONARY BYPASS

Model Number 10-80-00

Device Problem No Display/Image (1183)

Patient Problem No Patient Involvement (2645)

Event Date 11/20/2015

Event Type  No Answer Provided  

Manufacturer Narrative

There was no patient involvement.Device has not been returned to sorin group deutschland.Sorin group (b)(4) manufactures the s5 roller pump.The incident occurred in (b)(6).This medwatch report is being filed on behalf of sorin (b)(4).Sorin (b)(4) received a report that the touch screen of the s5 roller pump became unresponsive during priming.There was no patient involvement.The investigation is ongoing.A follow-up report will be sent when the investigation is complete.

Event Description

Sorin group (b)(4) received a report that the touch screen of the s5 roller pump became unresponsive during priming.There was no patient involvement.

Manufacturer Narrative

Livanova (b)(4) manufactures the s5 system.The incident occurred in.This medwatch report is being filed on behalf of livanova (b)(4).A livanova field service representative was dispatched to the facility for investigation.The field service representative confirmed the complaint.The touchscreen was replaced to resolve the reported issue.Nvmem was cleared on new touchscreen, pump settings were re-installed, and the unit was returned to service.A review of the dhr did not identify any deviations or nonconformities relevant to the reported issue.Evaluated on site by livanova rep.

• Brand Name: S5 ROLLER PUMP
• Type of Device: CONSOLE, HEART-LUNG MACHINE, CARDIOPULMONARY BYPASS
• Manufacturer (Section D): SORIN GROUP DEUTSCHLAND GMBH; lindberghstr. 25; munich,
• Manufacturer (Section G): LIVANOVA DEUTSCHLAND; lindberghstr. 25; munich 80939 ; GM 80939
• Manufacturer Contact: joan ceasar ; 14401 w. 65th way; arvada, CO 80004 ; 2812287260
• MDR Report Key: 5317242
• MDR Text Key: 34074696
• Report Number: 9611109-2015-00608
• Device Sequence Number: 1
• Product Code: DWB
• Combination Product (y/n): N
• Reporter Country Code: UK
• PMA/PMN Number: K071318
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: health professional
• Reporter Occupation: Health Professional
• Remedial Action: Other
• Type of Report: Initial,Followup
• Report Date: 07/19/2017

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?: Yes
• Device Operator: Health Professional
• Device Model Number: 10-80-00
• Device Catalogue Number: N/A
• Device Lot Number: N/A
• Was Device Available for Evaluation?: Yes
• Is the Reporter a Health Professional?: Yes
• Initial Date Manufacturer Received: 11/24/2015
• Initial Date FDA Received: 12/21/2015
• Supplement Dates Manufacturer Received: 07/11/2017
• Supplement Dates FDA Received: 07/19/2017
• Was Device Evaluated by Manufacturer?: No
• Date Device Manufactured: 07/22/2014
• Is the Device Single Use?: No
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: Reuse
• Patient Sequence Number: 1