MAUDE Adverse Event Report: DATASCOPE CORP. - MAHWAH CS100; SYSTEM, BALLOON, INTRA-AORTIC AND CONTROL

Catalog Number	0998-00-3013-64
Medical Device Problem Code	Failure to Power Up (1476)
Health Effect - Clinical Code	No Patient Involvement (2645)
Date of Event	10/06/2020
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
Additional information has been requested, and we will report accordingly if it becomes available.Not returned to manufacturer.
Event or Problem Description
It was reported that the cs100 intra-aortic balloon pump (iabp) would not power up using either mains or batteries.There was no patient involvement, and no adverse event reported.
Additional Manufacturer Narrative
A getinge field service engineer (fse) evaluated the iabp and was able to reproduce the reported issue.The fse replaced the power supply module, on/off switch and batteries to resolve the issue.The fse completed all safety, functionality and calibration checks and all tests passed to factory specifications.
Event or Problem Description
It was reported that the cs100 intra-aortic balloon pump (iabp) would not power up using either mains or batteries.There was no patient involvement, and no adverse event reported.

• Brand Name: CS100
• Common Device Name: SYSTEM, BALLOON, INTRA-AORTIC AND CONTROL
• Manufacturer (Section D): DATASCOPE CORP. - MAHWAH; 1300 macarthur blvd; mahwah NJ 07430
• MDR Report Key: 10734001
• Report Number: 2249723-2020-01762
• Device Sequence Number: 3450847
• Product Code: DSP
• UDI-Device Identifier: 10607567112664
• UDI-Public: 10607567112664
• Combination Product (Y/N): N
• Initial Reporter Country: TS
• PMA/510(K) Number: K031636
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: company representative,foreig
• Initial Reporter Occupation: Other
• Type of Report: Initial,Followup
• Report Date (Section B): 01/26/2021

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
• Operator of Device: Other
• Device Catalogue Number: 0998-00-3013-64
• Was Device Available for Evaluation?: Yes
• Initial Date Received by Manufacturer: 10/06/2020
• Supplement Date Received by Manufacturer: 01/25/2021
• Initial Report FDA Received Date: 10/26/2020
• Supplement Report FDA Received Date: 01/26/2021
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1