MAUDE Adverse Event Report: ARGON MEDICAL DEVICES OPTION RETRIEVABLE VENA CAVA FILTER SYSTEM; RETRIEVABLE IVC FILTER

Model Number 352506070

Device Problem Coagulation in Device or Device Ingredient (1096)

Patient Problems Perforation (2001); Thrombosis/Thrombus (4440)

Event Date 06/08/2011

Event Type  Injury  

Manufacturer Narrative

Sample is unavailable for evaluation.Without such evidence to review, the complaint cannot be confirmed.If additional information is provided in the future, a follow-up report will be submitted.

Event Description

According to the notice received by way of a civil action complaint, the patient was prescribed and implanted with an option vena cava filter on or about (b)(6) 2011 by dr.(b)(6) at (b)(6) hospital in (b)(6).The complaint alleges there was filter thrombosis post implant and perforation.The filter was not retrieved.Argon¿s attorneys are attempting to gather additional information.

• Brand Name: OPTION RETRIEVABLE VENA CAVA FILTER SYSTEM
• Type of Device: RETRIEVABLE IVC FILTER
• Manufacturer (Section D): ARGON MEDICAL DEVICES; 1445 flat creek rd; athens TX 75751
• Manufacturer Contact: gina liu ; 1445 flat creek rd; athens, TX 75751 ; 9036759321
• MDR Report Key: 12053939
• MDR Text Key: 258007642
• Report Number: 0001625425-2021-01008
• Device Sequence Number: 1
• Product Code: DTK
• Combination Product (y/n): N
• Reporter Country Code: US
• PMA/PMN Number: K081410
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: other
• Reporter Occupation: Other
• Type of Report: Initial
• Report Date: 06/23/2021

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 06/23/2021
• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: Yes
• Device Operator: Health Professional
• Device Expiration Date: 03/01/2014
• Device Model Number: 352506070
• Device Lot Number: S34808
• Was Device Available for Evaluation?: No
• Was the Report Sent to FDA?: No
• Date Manufacturer Received: 05/29/2021
• Was Device Evaluated by Manufacturer?: Device Not Returned to Manufacturer
• Is the Device Single Use?: Yes
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: N
• Patient Sequence Number: 1
• Patient Outcome(s): Other