| Common Device Name | Temporary Non-Roller Type Left Heart Support Blood Pump |
| Manufacturer (Section D) |
| Abiomed, Inc. - 1220648 |
| 22 cherry hill drive |
| danvers MA 01923 |
|
| Manufacturer Contact |
|
derek
sammarco
|
| 22 cherry hill drive |
| danvers, MA 01923
|
|
+1(781)493-4967
|
|
| MDR Report Key | 50888805 |
| Report Number | 1220648-2026-13322 |
| Device Sequence Number | 18589796 |
| Product Code |
OZD
|
| UDI-Device Identifier | 00813502012477 |
| UDI-Public | (01)00813502012477(17)280731(10)1994275 |
| Combination Product (Y/N) | N |
| Initial Reporter Country | JA |
| Number of Events Summarized | 1 |
| Summary Report (Y/N) | N |
| Serviced by Third Party (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 |
| Report Date (Section B) |
09/24/2026 |
| 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 Catalogue Number | 2000456 |
| 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 | 09/09/2026 |
| Initial Report FDA Received Date | 09/24/2026 |
| Was Device Evaluated by Manufacturer? (Y/N) |
No
|
| Date Device Manufactured | 09/11/2025 |
| 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 | 50 YR |
| Patient Sex | Male |
| Patient Race | Asian |