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Model Number CMCV-009-XLG
Device Problem Adverse Event Without Identified Device or Use Problem (2993)
Patient Problem Unspecified Infection (1930)
Event Date 12/07/2021
Event Type  Injury  
Manufacturer Narrative
No sample was returned for evaluation. Manufacturing review of the referenced lot number and respective device history record was conducted on 23dec2021, showing that all units were quality released on 13apr2021 having met all internal qc acceptance requirements. A nonconformance was identified with respect to the final packaging of this lot, however had no impact on the final release. The sterile subassembly lot was also reviewed and showed this subassembly lot was released to component inventory on 30nov2020 having met all quality requirements including product sterility testing following eo sterilization, as well as internal bioburden and product pyrogen (lal) testing requirements. In lieu of a request for the oem supplier for a dhr review of the ecm material lots, it is noted that aziyo processes the non-sterile envelope materials by cutting, suturing, packaging, and sterilizing. It is also noted that per the instructions for use (ifu - art-20662c) provided with the finished cangaroo envelope device, infection is listed as a potential complication associated with this procedure and device usage. The reported infection was limited to the pocket. The presence of a hematoma 14 days prior to the diagnosis of infection could reasonably have been related if there was any breach of the incision line or any contamination during the surgery itself. The aziyo device was a sterile product and unlikely to have been the cause of the hematoma or the infection. The procedure itself, with creation of the pocket, the placement of the cied, the cangaroo envelope and the leads is at risk for the introduction of bacteria from the surrounding skin, with subsequent closure of these devices in an anaerobic environment conducive to bacterial growth. Although the exact cause of the reported infection event cannot be conclusively determined, infection is a known complication associated with the use of a cangaroo envelope and the surgical implant procedure to place the cied, aziyo device, and the leads. Should any additional information be received related to this event, a follow-up report will be submitted.
Event Description
Email received from aziyo representative with report of patient with post-op pocket infection. Change-out procedure of an icd with aziyo cangaroo envelope device model cmcv-009-xlg, lot number m21d1130 was done on (b)(6)2021. The patient returned to the hospital two hours post discharge after his change-out procedure reporting a hematoma. The patient returned to the hospital on (b)(6) 2021 with suspected pocket infection and was placed on iv antibiotics. The icd and accompanying cangaroo envelope were explanted on (b)(6) 2021. The physician reported that he believes that the hematoma led to the pocket infection and was probably due to the procedure and not caused by the aziyo device.
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Manufacturer (Section D)
1100 old ellis road
ste 1200
roswell GA 30076
Manufacturer (Section G)
1100 old ellis road
ste 1200
roswell GA 30076
Manufacturer Contact
michael hennick
1100 old ellis road
ste 1200
roswell, GA 30076
MDR Report Key13170360
MDR Text Key288590525
Report Number3005619880-2022-00001
Device Sequence Number1
Product Code FTM
Combination Product (y/n)N
Reporter Country CodeUS
PMA/PMN Number
Number of Events Reported1
Summary Report (Y/N)N
Report Source Manufacturer
Source Type Health Professional,Company Representative
Reporter Occupation
Type of Report Initial
Report Date 01/05/2022
1 Device was Involved in the Event
1 Patient was Involved in the Event
Date FDA Received01/05/2022
Is this an Adverse Event Report? Yes
Is this a Product Problem Report? No
Device Operator
Device Model NumberCMCV-009-XLG
Device Lot NumberM21D1130
Was Device Available for Evaluation? No
Is the Reporter a Health Professional? Yes
Date Manufacturer Received12/10/2021
Was Device Evaluated by Manufacturer? Device Not Returned to Manufacturer
Date Device Manufactured04/13/2021
Is the Device Single Use? Yes
Is This a Reprocessed and Reused Single-Use Device? No
Type of Device Usage Initial

Patient Treatment Data
Date Received: 01/05/2022 Patient Sequence Number: 1