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Catalog Number 0684-00-0293
Device Problems Material Rupture (1546); Device Contamination with Body Fluid (2317); Device Displays Incorrect Message (2591)
Patient Problems Death (1802); Low Blood Pressure/ Hypotension (1914); Ischemia (1942); Nausea (1970); Vomiting (2144); Tingling (2171); Numbness (2415); Loss Of Pulse (2562)
Event Date 12/28/2017
Event Type  Death  
Manufacturer Narrative
Concomitant medical products: (continued due to space limits in the field): vasopressors (vaso) 0. 04 units/min, epinephrine (ep) 0. 04 units/hr, dubutamine 5 mcg, metformin 500 mg, aspirin (asa) 81 mg. The product was not returned and so could not be evaluated. It was discarded by the user. There was no reported malfunction of the device. If new information becomes available, a supplemental report will be submitted. (b)(4).
Event Description
It was reported that a patient had an intra-aortic balloon (iab) ruptured during procedure. The patient was transferred to the facility as a high risk percutaneous coronary intervention (pci) patient and had a competitor device inserted in left groin from a different facility. The patient required a right coronary artery (rca) spiral dissection and competitor device removal. After removal of competitor iab, a 34cc linear was inserted in the left groin at customer site on (b)(6) 2017 at 17:00. Sometime after insertion, there was an alarm generated which created a concern that there may have been an iab rupture. Upon arrival at bedside, it was noted that the patient had blood in the iab pressure tubing and iab pump console had been on standby for about 5 minutes with alarms indicating rupture. At that time, the patient was on vasopressin 0. 02 units/min as well as dobutamine (dba) at 5 mcg/kg/min. Patient's blood pressure started to drop without iab assistance, norepinephrine was initiated to maintain mean arterial pressure (map) above 65 mmhg. Norepinephrine at 0. 7 mcg/kg/min in addition to the vasopressin at 0. 04 units/min was required to maintain her map goal during this time. Patient also became nauseated and had episodes of vomiting during this time with increasing pressor requirements. On (b)(6) 2017 at 22:30, it was noted that there was an iab rupture. Decision was made to urgently replace the iab via patient¿s right common femoral artery (cfa) at bedside. After speaking with the physician, the iab was removed from the left cfa 8fr sheath and then proceeded to remove the sheath. No thrombus was seen at the time of bleed back once the sheath was removed iab was intact and was saved to be checked by the manufacturer. Hemostasis of her left cfa access site was achieved with manual pressure. Patient¿s groin was prepped and all five maximum sterile barriers were used. Patient was given local anesthetic with lidocaine 1% without epinephrine at the right cfa site. A micro-puncture catheter was used to obtain right cfa access and a 4fr sheath was initially placed in the right cfa. Appropriate placement was confirmed via chest x-ray (cxr); iab was secured with suture and stat locks and a clear dressing was applied. The second iab (mega 40cc) was inserted successfully. Post-procedure, patient had good augmentation with blood pressure (b/p) to the 150's. Pressors were weaned off and patient remained only on dba at 5 mcg/kg/min. Patient did not have left dorsalis pedis (dp), posterior tibial (pt), or popliteal pulses by doppler. Right pt was present as a monophasic waveform with doppler, however right dp was not present with doppler. Patient was started on heparin gtt (drops) without bolus about 1 hour after iabp placement urgently a complete blood count (cbc) was checked. 1gm intravenous (iv) vancomycin also was given for prophylaxis. Bear hugger and warming blanket applied to patient's legs. At 06:20 patient had b/l dp and pt pulses present with doppler. Testing was performed for hemoglobin (hgb), creatinine (cr), mixed venous oxygen saturation (svo2), central venous pressure (cvp), and urinary output (uop). Furosemide gtt was at 20 mg/hr, also decided to add iv chlorothiazide 250 mg x 1 and monitor uop. Approximately 8 hours later on (b)(6) 2017 at 07:00, patient complained about tingling/numbness to left foot. Patient could not feel anything from knee down to foot. An ultrasound showed nearly occluded left cfa & possibly nearly occluded external iliac artery (eia). Lowered flow velocities were noted throughout entire left lower leg. Limb ischemia reported prior to patient death. Patient death occurred on (b)(6) 2018. Indication for use: multivessel disease. This is report 2 of 2 for iab (mega 34cc) where there was no reported malfunction.
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Brand NameMEGA 7.5FR. 40CC IAB
Manufacturer (Section D)
15 law drive
fairfield NJ 07004
Manufacturer (Section G)
15 law drive
fairfield NJ 07004
Manufacturer Contact
15 law drive
fairfield, NJ 07004
MDR Report Key7223826
MDR Text Key98406187
Report Number2248146-2018-00052
Device Sequence Number1
Product Code DSP
Combination Product (y/n)N
Reporter Country CodeUS
PMA/PMN Number
Number of Events Reported1
Summary Report (Y/N)N
Report Source Manufacturer
Source Type company representative,health
Reporter Occupation
Type of Report Initial
Report Date 01/23/2018
1 Device was Involved in the Event
1 Patient was Involved in the Event
Date FDA Received01/27/2018
Is this an Adverse Event Report? Yes
Is this a Product Problem Report? No
Device Operator
Device Expiration Date06/01/2020
Device Catalogue Number0684-00-0293
Device Lot Number3000053157
Was Device Available for Evaluation? No
Is the Reporter a Health Professional?
Was the Report Sent to FDA?
Device AgeYR
Event Location No Information
Date Manufacturer Received12/29/2017
Was Device Evaluated by Manufacturer? No Answer Provided
Date Device Manufactured05/23/2017
Is the Device Single Use? Yes
Is This a Reprocessed and Reused Single-Use Device? No
Type of Device Usage

Patient Treatment Data
Date Received: 01/27/2018 Patient Sequence Number: 1