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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: WILLIAM COOK EUROPE GUNTHER TULIP NAVALIGN JUGULAR VENA CAVA FILTER SET; DTK FILTER, INTRAVASCULAR, CARDIOVASCULAR
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WILLIAM COOK EUROPE GUNTHER TULIP NAVALIGN JUGULAR VENA CAVA FILTER SET; DTK FILTER, INTRAVASCULAR, CARDIOVASCULAR Back to Search Results
Catalog Number IGTCFS-65-1-JUG-TULIP
Device Problems Difficult to Remove (1528); Activation Problem (4042)
Patient Problem No Information (3190)
Event Type  Injury  
Event Description
Description of event according to initial reporter: we received information on (b)(6) 2019 that shows that there were two devices involved in the implant and one had to be removed.The ivc was patent with normal configuration and caliber and was free of thrombus.The initial inferior vena cava filter failed to deploy properly and had to be recovered.This recovery was complicated by laceration to the inferior cava which was treated by balloon tip not.The level of the renal veins was noted.The inferior vena cava filter was deployed in the infrarenal inferior vena cava.Patient outcome: follow up intervening cavogram demonstrated no active extravasation of contrast.A new inferior vena cava filter was deployed.
 
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Brand Name
GUNTHER TULIP NAVALIGN JUGULAR VENA CAVA FILTER SET
Type of Device
DTK FILTER, INTRAVASCULAR, CARDIOVASCULAR
Manufacturer (Section D)
WILLIAM COOK EUROPE
sandet 6
bjaeverskov 4632
DA  4632
MDR Report Key9451386
MDR Text Key172593710
Report Number3005580113-2019-00890
Device Sequence Number1
Product Code DTK
Combination Product (y/n)N
Reporter Country CodeUS
Number of Events Reported1
Summary Report (Y/N)N
Report Source Distributor
Reporter Occupation Other
Type of Report Initial
Report Date 12/11/2019
1 Device was Involved in the Event
1 Patient was Involved in the Event
Date FDA Received12/11/2019
Is this an Adverse Event Report? Yes
Is this a Product Problem Report? Yes
Device Operator Health Professional
Device Catalogue NumberIGTCFS-65-1-JUG-TULIP
Device Lot NumberUNKNOWN
Was Device Available for Evaluation? No
Was the Report Sent to FDA? Yes
Date Report Sent to FDA12/11/2019
Distributor Facility Aware Date12/06/2019
Event Location Other
Date Report to Manufacturer12/11/2019
Is the Device Single Use? Yes
Is This a Reprocessed and Reused Single-Use Device? No
Type of Device Usage Initial
Patient Sequence Number1
Patient Outcome(s) Required Intervention;
Patient Weight63
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