MAUDE Adverse Event Report: EDWARDS LIFESCIENCES LLC SWAN-GANZ TRUE SIZE; CATHETER, INTRAVASCULAR, DIAGNOSTIC

Model Number	151F7
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	10/14/2020
Type of Reportable Event	Malfunction
Event or Problem Description
Elderly male with history of coronary artery disease and hypertension, recent ventricular tachycardia and ventricular fibrillation.While having a heart cath, the person inserting the swan ganz had problems threading the 0.25 wire.It was removed from the patient without known harm.

• Brand Name: SWAN-GANZ TRUE SIZE
• Common Device Name: CATHETER, INTRAVASCULAR, DIAGNOSTIC
• Manufacturer (Section D): EDWARDS LIFESCIENCES LLC; one edwards way; irvine CA 92614
• MDR Report Key: 10739847
• Report Number: 10739847
• Device Sequence Number: 1191574
• Product Code: DQO
• UDI-Device Identifier: 00690103000566
• UDI-Public: (01)00690103000566(17)220625(11)200625(10)63265287
• Combination Product (Y/N): N
• Initial Reporter State: OH
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: User Facility
• Initial Reporter Occupation: Risk Manager
• Type of Report: Initial
• Report Date (Section B): 10/16/2020
• Report Date (Section F): 10/16/2020

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: Health Professional
• Device Model Number: 151F7
• Device Catalogue Number: 151F7
• Device Lot Number: 63265287
• Was Device Available for Evaluation?: Yes
• Was the Report Sent to FDA?: Yes
• Event Location: Hospital
• Date Report to Manufacturer: 10/27/2020
• Initial Date Received by Manufacturer: Not provided
• Initial Report FDA Received Date: 10/27/2020
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1
• Patient Weight: 76
• Date Report Sent to FDA: 10/16/2020