MAUDE Adverse Event Report: ST. JUDE MEDICAL, INC. SJM SéGUIN SEMI-RIGID ANNULOPLASTY RING; RING, ANNULOPLASTY

Model Number	SARP-32
Medical Device Problem Code	Expiration Date Error (2528)
Health Effect - Clinical Code	No Known Impact Or Consequence To Patient (2692)
Date of Event	09/07/2018
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
An event of implantation of an expired product was reported.The 32 mm semi-rigid annuloplasty ring batch number 4783013 expired on august 27, 2018 which was prior to the reported event date of (b)(6) 2018.A review of distribution records confirmed that this product was distributed prior to its expiration date.The device history record was reviewed to ensure that each manufacturing and inspection operation was performed, including verification of the expiration date listed on the product label.The root cause of the reported event is consistent with user error.Additionally, per the instructions for use (ifu) "do not use the ring if the ¿use by¿ date on the packaging has passed.".
Event or Problem Description
On (b)(6) 2018, a 32 mm semi-rigid annuloplasty ring (sarp) was selected for a mitral repair after a quadrangular p2 resection.The sarp rings had been scattered on the back table searching for the correct size.The circulator handed the ring to the physician without verifying the expiration date.The physician sutured in the ring and as the procedure was being completed, an operating room staff member identified the device had an expiration date of (b)(6) 2018.The physician elected to leave the device implanted and closed the patient's chest.Post-operatively, the patient was reported to be stable.The patient was notified about the device expiration, and no additional precautions have been taken.The patient has since been discharged on antibiotics.

• Brand Name: SJM SéGUIN SEMI-RIGID ANNULOPLASTY RING
• Common Device Name: RING, ANNULOPLASTY
• Manufacturer (Section D): ST. JUDE MEDICAL, INC.; 177 east county road b; st. paul MN 55117
• MDR Report Key: 7913075
• Report Number: 3007113487-2018-00023
• Device Sequence Number: 930708
• Product Code: KRH
• UDI-Device Identifier: 05414734007528
• UDI-Public: 05414734007528
• Combination Product (Y/N): N
• Initial Reporter State: IA
• Initial Reporter Country: US
• PMA/510(K) Number: K092310
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: company representative,health
• Initial Reporter Occupation: Physician
• Type of Report: Initial,Followup
• Report Date (Section B): 10/03/2018

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: No
• Operator of Device: Health Professional
• Device Expiration Date: 08/27/2018
• Device Model Number: SARP-32
• Device Catalogue Number: SARP-32
• Device Lot Number: 4783013
• Was Device Available for Evaluation?: No
• Was the Report Sent to FDA?: No
• Initial Date Received by Manufacturer: 09/10/2018
• Supplement Date Received by Manufacturer: 09/10/2018
• Initial Report FDA Received Date: 09/26/2018
• Supplement Report FDA Received Date: 10/03/2018
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1
• Outcome Attributed to Adverse Event: Other
• Patient Age: 57 YR
• Patient Weight: 96