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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: MEDTRONIC HEART VALVES DIVISION PROFILE 3D RING, ANNULOPLASTY

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MEDTRONIC HEART VALVES DIVISION PROFILE 3D RING, ANNULOPLASTY Back to Search Results
Model Number 680R26
Device Problem Inadequacy of Device Shape and/or Size
Event Date 08/23/2019
Event Type  Injury  
Manufacturer Narrative

Product analysis: no product was returned. Conclusion: without the return of the product, no definitive conclusion can be made regarding the clinical observation. If information is provided in the future, a supplemental report will be issued.

 
Event Description

Medtronic received information that immediately post implant of this 26mm mitral annuloplasty ring, the ring was explanted and replaced with a 25mm annuloplasty ring of a different model. The physician stated that the 26mm ring was not the right size for the patient. No additional adverse patient effects were reported.

 
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Brand NamePROFILE 3D
Type of DeviceRING, ANNULOPLASTY
Manufacturer (Section D)
MEDTRONIC HEART VALVES DIVISION
1851 e deere ave
santa ana CA 92705
Manufacturer (Section G)
MEDTRONIC HEART VALVES DIVISION
1851 e deere ave
santa ana CA 92705
Manufacturer Contact
paula bixby
8200 coral sea street ne
mounds view , MN 55112
7635055378
MDR Report Key9167028
Report Number2025587-2019-03072
Device Sequence Number1
Product CodeKRH
Report Source Manufacturer
Source Type COMPANY REPRESENTATIVE,HEALTH
Reporter Occupation
Type of Report Initial
Report Date 10/08/2019
1 Device Was Involved in the Event
1 Patient Was Involved in the Event
Date FDA Received10/08/2019
Is This An Adverse Event Report? Yes
Is This A Product Problem Report? No
Device Operator HEALTH PROFESSIONAL
Device MODEL Number680R26
Device Catalogue Number680R26
Was Device Available For Evaluation? No
Is The Reporter A Health Professional? Yes
Was the Report Sent to FDA?
Event Location No Information
Date Manufacturer Received09/09/2019
Was Device Evaluated By Manufacturer? No Answer Provided
Date Device Manufactured06/13/2018
Is The Device Single Use? Yes
Is this a Reprocessed and Reused Single-Use Device? No
Type of Device Usage Initial

Patient TREATMENT DATA
Date Received: 10/08/2019 Patient Sequence Number: 1
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