MAUDE Adverse Event Report: INTERVASCULAR SAS INTERGARD WOVEN AORTIC ARCH; PROSTHESIS, VASCULAR GRAFT, OF 6MM AND GREATER DIAMETER

Model Number	HEWAA2810080810/1
Medical Device Problem Code	Product Quality Problem (1506)
Health Effect - Clinical Code	No Patient Involvement (2645)
Date of Event	10/16/2019
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
It was reported that the product is available for investigation, it should be returned to intervascular for examination.The review of historical data indicated that this is the second case on three complaints which were reported for the same sterilization lot and the same product reference.The investigation is ongoing.The device history records review concludes that there is no non-conformance / planned deviation in relation with the event reported.The investigation is still ongoing.A follow-up report will be sent upon completion of the investigation.
Event or Problem Description
When the customer open the package ,they found there was yellow blot on the inner packing.
Additional Manufacturer Narrative
(10/193) the involved product was returned to intervascular and was visually inspected by our quality assurance (qa) supervisor.Results are as follows: "after manual peeling of the internal blister lid, it appears that yellowish aureoles are visible on the lid corresponding to the location of the product in the internal blister." "there is no collagen excess on the external or internal surface of the product" the conclusions are that the product is not compliant with our list of standards for acceptation and rejection for packaging and that root cause is unclear but probably related to inappropriate storage conditions by logistic actors.(11/213) and (4102/213) two retentions samples were selected and visually inspected by our quality assurance (qa) supervisor : (11/213) one retention sample from same sterilization lot and coated on the same coating period as the involved device (coated 5 days before) (4102/213) one retention sample from another sterilization lot (17c16) and coated on the same coating period as the involved device (coated 6 days after) his observations are as follows : "i performed a visual inspection on the two retention products listed below.There is no collagen excess on the external or internal surface of the products and no halos are apparent on the internal lids of these two products.The two retention products from sterilization lots 17c09 and 17c16 are compliant, with no apparent similarity on these products in relation with the events reported on sterilization lot 17c09." (4109/193) the review of historical data indicated that this is the second case on three complaints which were reported for the same sterilization lot and the same product reference.The investigation indicates that the three products were defective probably due to inappropriate storage conditions by logistic actors.(4315) no conclusion can be drawn on the exact origin of the defect of these three products from same sterilization lot.The conducted investigation suggests that the device was not defective at the time of manufacturing.However, the product, as it was returned to intervascular, does not conform to the specification.Therefore, a non-conformity report has been initiated in order to investigate the root cause and take appropriate corrective actions if necessary.
Event or Problem Description
Mfr report number : 1640201-2019-00086.Complaint #: (b)(4).

• Brand Name: INTERGARD WOVEN AORTIC ARCH
• Common Device Name: PROSTHESIS, VASCULAR GRAFT, OF 6MM AND GREATER DIAMETER
• Manufacturer (Section D): INTERVASCULAR SAS; zone industrielle athelia i; la ciotat
• MDR Report Key: 9336895
• Report Number: 1640201-2019-00086
• Device Sequence Number: 16606703
• Product Code: DSY
• UDI-Device Identifier: 00384401010753
• UDI-Public: 00384401010753
• Combination Product (Y/N): N
• Initial Reporter Country: CH
• PMA/510(K) Number: K013651
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: company representative
• Initial Reporter Occupation: Other Health Care Professional
• Type of Report: Initial,Followup
• Report Date (Section B): 01/06/2020

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 Expiration Date: 02/28/2022
• Device Model Number: HEWAA2810080810/1
• Device Catalogue Number: HEWAA2810080810/1
• Device Lot Number: 17C09
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 11/25/2019
• Initial Date Received by Manufacturer: 10/24/2019
• Supplement Date Received by Manufacturer: 12/09/2019
• Initial Report FDA Received Date: 11/18/2019
• Supplement Report FDA Received Date: 01/06/2020
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1