inforMED
MalfunctionDPW

GEM FLOW COUPLER

Received Jun 15, 2024

Report 1416980-2024-02926 · MDR key 19544379

Device

Generic name

Flowmeter, Blood, Cardiovascular

Model number

GEM2753FC

Catalog number

515101250010

Lot number

SP23L04-1985433

Product problems

  • Break
  • Break

Patient

NA · Unknown

  • No Clinical Signs, Symptoms or Conditions
  • No Clinical Signs, Symptoms or Conditions

Narrative

Additional Manufacturer Narrative

SHOULD ADDITIONAL RELEVANT INFORMATION BECOME AVAILABLE, A SUPPLEMENTAL REPORT WILL BE SUBMITTED.

Description of Event or Problem

IT WAS REPORTED THAT A 2.5MM FLOW COUPLER WAS BROKEN (NOT FURTHER SPECIFIED). THIS WAS IDENTIFIED PRIOR TO PATIENT USE. THERE WAS NO PATIENT INVOLVEMENT. NO ADDITIONAL INFORMATION IS AVAILABLE.

Additional Manufacturer Narrative

ADDITIONAL INFORMATION: D4, D9, H3, H4, H6, H11. H11: THE ACTUAL FLOW COUPLER DEVICE WAS NOT AVAILABLE; HOWEVER, THE PACKAGING COMPONENTS WERE RETURNED (CARTON, INSTRUCTIONS FOR USE, IMPLANT RECORD, AND OUTER TRAY WITH LID PULLED BACK). VISUAL INSPECTION OF THE PACKAGING COMPONENTS DID NOT IDENTIFY ANY ABNORMALITIES THAT COULD HAVE CONTRIBUTED TO THE REPORTED CONDITION. THE REPORTED CONDITION WAS NOT VERIFIED. A BATCH REVIEW WAS CONDUCTED AND THERE WERE NO DEVIATIONS FOUND RELATED TO THIS REPORTED CONDITION DURING THE MANUFACTURE OF THIS LOT. SHOULD ADDITIONAL RELEVANT INFORMATION BECOME AVAILABLE, A SUPPLEMENTAL REPORT WILL BE SUBMITTED.