| Brand Name | Heater Cooler 3T System |
| Common Device Name | Controller, Temperature, Cardiopulmonary Bypass |
| Manufacturer (Section D) |
| LivaNova Deutschland |
| lindberghstraße 25 |
| munich 80939 |
| GM 80939 |
|
| Manufacturer (Section G) |
| LivaNova Deutschland |
| lindberghstraße 25 |
|
| munich 80939 |
|
GM
80939
|
|
| Manufacturer Contact |
|
annarita
di lascio
|
| 14401 w. 65th way |
| arvada, CO
|
|
| MDR Report Key | 50671901 |
| Report Number | 9611109-2026-90411 |
| Device Sequence Number | 13301680 |
| Product Code |
DWC
|
| UDI-Device Identifier | 04033817900528 |
| Combination Product (Y/N) | N |
| Initial Reporter Country | US |
| PMA/510(K) Number | K220635 |
| Number of Events Summarized | 1 |
| Summary Report (Y/N) | N |
| Reporter Type |
Manufacturer
|
| Type of Report
| Initial |
| 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 |
Health Professional
|
| Device Model Number | HEATER/COOLER 3T 120V/60 HZ |
| Device Catalogue Number | 16-02-85 |
| Was Device Available for Evaluation? |
No
|
| Is the Reporter a Health Professional? |
No
|
| Type of Report(Section G) | Thirty-Day |
| Initial Date Received by Manufacturer | 08/10/2026 |
| Initial Report FDA Received Date | 09/08/2026 |
| Date Device Manufactured | 06/15/2023 |
| Patient Sequence Number | 1 |
| Patient Sex | Unknown |
|
|