inforMED
MalfunctionFPK

NAVILYST MEDICAL

Received Mar 16, 2015 · Event occurred Jan 27, 2015

Report 1317056-2015-00075 · MDR key 4617532

Device

Generic name

High Pressure Contrast Injection Line

Manufacturer

Navilyst Medical

Model number

NA

Catalog number

H965920517231

Lot number

4834959

Product problems

  • Air Leak
  • Device Operates Differently Than Expected

Patient

Not reported

  • No Consequences Or Impact To Patient

Narrative

Additional Manufacturer Narrative

SAMPLES HAVE BEEN RETURNED FOR EVALUATION, HOWEVER THE INVESTIGATION INTO THIS EVENT IS ON-GOING. UPON COMPLETION OF THE INVESTIGATION, A SUPPLEMENTAL MEDWATCH WILL BE SUBMITTED. (B)(4).

Description of Event or Problem

HOSPITAL REPORTED VISUALIZING AIR BUBBLES WITH A NAVILYST MEDICAL HIGH PRESSURE CONTRAST INJECTION LINE WITH MALE ROTATING ADAPTOR DURING A PROCEDURE. THEY BELIEVED THAT THE AIR BUBBLES WERE COMING FROM THE ROTATING ADAPTOR. THERE WAS NO AIR INJECTION OR PT INJURY. THE USED DEVICE WAS DISCARDED AT THE HOSPITAL, HOWEVER THEY RETURNED AN UNUSED DEVICE FROM THE SAME LOT.