Brand Name | IMPELLA |
Type of Device | CONTROL, PUMP SPEED, CARDIOPULMONARY BYPASS |
Manufacturer (Section D) |
|
MDR Report Key | 12589612 |
MDR Text Key | 275154815 |
Report Number | MW5104432 |
Device Sequence Number | 1 |
Product Code |
DWA
|
Reporter Country Code | US |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Voluntary
|
Reporter Occupation |
Patient Family Member or Friend
|
Type of Report
| Initial,Followup |
Report Date |
10/14/2021 |
2 Devices were Involved in the Event: |
1
2
|
1 Patient was Involved in the Event |
|
Date FDA Received | 10/07/2021 |
Is this an Adverse Event Report? |
Yes
|
Is this a Product Problem Report? |
Yes
|
Device Operator |
Health Professional
|
Was Device Evaluated by Manufacturer? |
No Information
|
Type of Device Usage |
N
|
Patient Sequence Number | 1 |
Patient Outcome(s) |
Death;
|
Patient Age | 61 YR |
Patient Weight | 75 |
|
|