MAUDE Adverse Event Report: DATASCOPE CORP. TRANSRAY 40CC; SYSTEM, BALLOON, INTRA-AORTIC AND CONTROL

Model Number	0684-00-0470-01
Medical Device Problem Code	Gas/Air Leak (2946)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	05/02/2025
Type of Reportable Event	Malfunction
Event or Problem Description
It was reported that during use on patient, transray 40cc intra-aortic balloon (iab) was inserted in patient and an alarm of "iab circuit leak (gas loss)" occurred on cs300 iabp.Similar alarms occurred frequently hence the catheter was replaced with another tr4055.No blood was found in the extension tube.There was no harm reported to the patient.
Additional Manufacturer Narrative
Additional information: due to characterization limit e1 (initial reporter: (b)(6)).The device has not been returned to the manufacturer so we are unable to complete an evaluation.If provided we will send a supplemental report with our additional findings.Complaint record id # (b)(4).
Additional Manufacturer Narrative
Updated fields: b4; g3; g6; h2; h11 corrected fields: h6 type of investigation.
Additional Manufacturer Narrative
Updated fields: b4; e1 event site address, event site city, event site telephone; g1 contact person ¿ mfg site, g3; g6; h2; h11.
Event or Problem Description
N/a.
Additional Manufacturer Narrative
Updated fields: type of investigation, investigation findings, investigation conclusions, component code; h11.No decon or visual inspection performed since product was not returned and could not be evaluated.Therefore, we were unable to confirm or determine a root cause for the reported failure.The failure mode is addressed in the risk file and is operating within its risk profile.The ifu addresses the reported failure.The investigation does not indicate that the device was inadvertently released as non-conforming or an adulterated product or was a counterfeit.Each iab manufactured is 100% inspected and the controls put in place during the manufacturing of the iab would catch a defect and not allow non-conforming device to be released.The trend review did not identify an adverse trend (increase in number of complaints over past three (3) months).Based on the rational provided above, no escalation to the capa process is required.
Event or Problem Description
N/a.

• Brand Name: TRANSRAY 40CC
• Common Device Name: SYSTEM, BALLOON, INTRA-AORTIC AND CONTROL
• Manufacturer (Section D): DATASCOPE CORP.; 15 law drive; fairfield NJ 07004
• Manufacturer (Section G): DATASCOPE CORP.; 15 law drive; fairfield NJ 07004
• Manufacturer Contact: lori gosselin ; 15 law drive; fairfield, NJ 07004
• MDR Report Key: 22062134
• Report Number: 2248146-2025-0000278
• Device Sequence Number: 18051034
• Product Code: DSP
• UDI-Device Identifier: 10607567106779
• UDI-Public: (01)10607567106779
• Combination Product (Y/N): N
• Initial Reporter Country: JA
• PMA/510(K) Number: K063525
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: Foreign,Health Professional,User Facility,Company Representative
• Initial Reporter Occupation: Other Health Care Professional
• Type of Report: Initial,Followup,Followup,Followup
• Report Date (Section B): 07/14/2025

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: 0684-00-0470-01
• Device Catalogue Number: 0684-00-0470-01
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 05/07/2025
• Supplement Date Received by Manufacturer: 06/25/2025; 07/08/2025; 07/09/2025
• Initial Report FDA Received Date: 05/21/2025
• Supplement Report FDA Received Date: 07/04/2025; 07/08/2025; 07/14/2025
• Was Device Evaluated by Manufacturer? (Y/N): No
• Is the Device Labeled for Single Use? (Y/N): Yes
• Usage of Device: Initial
• Patient Sequence Number: 1
• Concomitant Medical Products and Therapy/Usage Dates: CS300.
• Patient Sex: Unknown