| Brand Name | HEARTMATE®, MOBILE POWER UNIT, N/A |
| Common Device Name | Ventricular (Assist) Bypass |
| Manufacturer (Section D) |
| Thoratec Corporation |
| 6035 stoneridge drive |
| pleasanton CA 94588 |
|
| Manufacturer (Section G) |
| THORATEC CORPORATION |
| 6035 stoneridge drive |
|
| pleasanton CA 94588 |
|
| Manufacturer Contact |
|
fredric
gold
|
| 6035 stoneridge drive |
| pleasanton, CA 94588
|
|
+1(781)852-8207
|
|
| MDR Report Key | 25477671 |
| Report Number | 2916596-2026-2917488 |
| Device Sequence Number | 15744493 |
| Product Code |
DSQ
|
| UDI-Device Identifier | 05415067038234 |
| UDI-Public | (01)05415067038234(11)250618 |
| Combination Product (Y/N) | N |
| Initial Reporter State | IL |
| Initial Reporter Country | US |
| PMA/510(K) Number | P160054 |
| Number of Events Summarized | 1 |
| Summary Report (Y/N) | N |
| Serviced by Third Party (Y/N) | N |
| Reporter Type |
Manufacturer
|
| Report Source |
Health Professional,Company Representative |
| Initial Reporter Occupation |
Other Health Care Professional
|
| Type of Report
| Initial,Followup |
| Report Date (Section B) |
09/08/2026 |
| 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 |
Lay User/Patient
|
| Device Model Number | 107754 |
| Device Catalogue Number | 107754 |
| Device Lot Number | 10899284 |
| Was Device Available for Evaluation? |
Yes
|
| Date Returned to Manufacturer | 06/08/2026 |
| Is the Reporter a Health Professional? |
No
|
| Was the Report Sent to FDA? |
No
|
| Type of Report(Section G) | Thirty-Day |
| Initial Date Received by Manufacturer | 05/26/2026 |
| Supplement Date Received by Manufacturer | 09/04/2026
|
| Initial Report FDA Received Date | 06/11/2026 |
| Supplement Report FDA Received Date | 09/08/2026
|
| Was Device Evaluated by Manufacturer? (Y/N) |
Yes
|
| Date Device Manufactured | 06/18/2025 |
| 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 |
| Patient Age | 79 YR |
| Patient Sex | Male |
| Patient Weight | 217 LB |
| Patient Race | Black Or African American |