MAUDE Adverse Event Report: ARROW INTERNATIONAL LLC ARROW ULTRA 8 IAB: 8FR 40CC; SYSTEM, BALLOON, INTRA-AORTIC

Catalog Number	IAB-05840-U
Medical Device Problem Code	Device Alarm System (1012)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	01/22/2024
Type of Reportable Event	Malfunction
Event or Problem Description
It was reported that "frequent helium loss 2 alarms possible iab abrasion".Additionally, it was reported " persistent helium alarm loss 2 alarms occurring every 60 seconds or less.The iab was just inserted in the ccl, there is no blood noted in the tubing.They had already began switching out the pump prior to [calling support].The alarm continued on the second pump.Facetime assessment noted only slight partial obstruction on bpw, nsr, decreased iab volume to 35cc an attempted 1:2, helium alarms persisted, md agreed with iab removal.Iab was removed without incidence or difficulty and replaced with a second iab.No additional alarms after replacement.Patient transferred to icu, no additional alarms." no patient injury or consequence reported.Patient current condition reported as "fine".
Additional Manufacturer Narrative
(b)(4).
Event or Problem Description
It was reported that "frequent helium loss 2 alarms possible iab abrasion".Additionally, it was reported " persistent helium alarm loss 2 alarms occurring every 60 seconds or less.The iab was just inserted in the ccl, there is no blood noted in the tubing.They had already began switching out the pump prior to [calling support].The alarm continued on the second pump.Facetime assessment noted only slight partial obstruction on bpw, nsr, decreased iab volume to 35cc an attempted 1:2, helium alarms persisted, md agreed with iab removal.Iab was removed without incidence or difficulty and replaced with a second iab.No additional alarms after replacement.Patient transferred to icu, no additional alarms." no patient injury or consequence reported.Patient current condition reported as "fine".
Additional Manufacturer Narrative
Qn# (b)(4).The reported complaint for iab "frequent helium loss 2 alarms" is not able to be confirmed.The product was not returned for investigation.Based on a review of the device history record (dhr), the product met specification upon release.The root cause of the complaint is undetermined.No further action required at this time.The reported complaint will be monitored for any developing trends.If the product is returned at a later date, a full investigation of the sample will be completed.Teleflex will continue to monitor and trend on complaints of this nature.

• Brand Name: ARROW ULTRA 8 IAB: 8FR 40CC
• Common Device Name: SYSTEM, BALLOON, INTRA-AORTIC
• Manufacturer (Section D): ARROW INTERNATIONAL LLC; morrisville NC
• Manufacturer (Section G): ARROW INTERNATIONAL INC.; 16 elizabeth drive; chelmsford MA 01824
• Manufacturer Contact: mariah mackinnon ; 3015 carrington mill blvd; morrisville, NC 27560
• MDR Report Key: 18672192
• Report Number: 3010532612-2024-00096
• Device Sequence Number: 7128418
• Product Code: DSP
• UDI-Device Identifier: 00801902010759
• UDI-Public: 00801902010759
• Combination Product (Y/N): N
• Initial Reporter State: IN
• Initial Reporter Country: US
• PMA/510(K) Number: K000729
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: User Facility,Company Representative
• Initial Reporter Occupation: Nurse
• Type of Report: Initial,Followup
• Report Date (Section B): 01/22/2024

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 Expiration Date: 12/31/2024
• Device Catalogue Number: IAB-05840-U
• Device Lot Number: 18F23A0021
• Was Device Available for Evaluation?: Yes
• Is the Reporter a Health Professional?: Yes
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 01/22/2024
• Supplement Date Received by Manufacturer: 03/12/2024
• Initial Report FDA Received Date: 02/08/2024
• Supplement Report FDA Received Date: 03/15/2024
• Was Device Evaluated by Manufacturer? (Y/N): Device Not Returned to Manufacturer
• Date Device Manufactured: 01/12/2023
• Is the Device Labeled for Single Use? (Y/N): Yes
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Usage of Device: Initial
• Patient Sequence Number: 1
• Concomitant Medical Products and Therapy/Usage Dates: N/A.; N/A.
• Patient Sex: Unknown