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Adverse Event Report

DATASCOPE CORP./COLLAGEN PRODUCTS VASOSEAL VHD VASCULAR HEMOSTASIS DEVICE   back to search results
Model Number VHD
Event Date 05/08/2001
Event Type  Injury   Patient Outcome  Required Intervention;
Event Description

The customer reported that following a cardiac catheterization procedure in 2001, a vasoseal vhd was deployed. Following deployment, the patient complained of pain, and drainage was noted at the puncture site. A tissue sample was taken and sent to the lab for analysis. The pathology report diagnosis stated "fibroadipose tissue with inflammation and fibrosis consistent with reactive process. " it was noted that the findings may be indicative of an allergic component to the reactive process. No further complications were reported.

 
Manufacturer Narrative

Based on co's commercial experience, although co has received reports of allergic reaction following vasoseal deployment, the frequency of reported allergic reactions is extremely low. While allergic reactions to vasoseal collagen are not expected, some patients may experience a foreign body response, which may cause symptoms such as localized inflammation and edema. In addition, the degree of the response is very much patient dependent and therefore, the severity of symptoms will vary from patient to patient. The instructions for use states that since the vasoseal vhd is a collagen product; allergic reaction, foreign body reaction, inflammation, and edema are some of the potential adverse reactions associated with the use of collagen hemostats that should be considered.

 
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Brand NameVASOSEAL VHD
Type of DeviceVASCULAR HEMOSTASIS DEVICE
Baseline Brand NameVASOSEAL VHD
Baseline Generic NameVASCULAR HEMOSTASIS DEV
Baseline Model NumberVHD
Baseline Device 510(K) Number
Baseline Device PMA Number
Manufacturer (Section F)
DATASCOPE CORP./COLLAGEN PRODUCTS
1300 macarthur blvd.
mahwah NJ 07430
Manufacturer (Section D)
DATASCOPE CORP./COLLAGEN PRODUCTS
1300 macarthur blvd.
mahwah NJ 07430
Manufacturer Contact
laurie bonilla
1300 macarthur blvd.
mahwah , NJ 07430
(201) 995 -8775
Device Event Key325714
MDR Report Key336408
Event Key316639
Report Number9681824-2001-00081
Device Sequence Number1
Product CodeMGB
Report Source Manufacturer
Source Type Company Representative
Reporter Occupation Other
Type of Report Initial
Report Date 05/15/2001
1 Device Was Involved in the Event
1 Patient Was Involved in the Event
Date FDA Received06/08/2001
Is This An Adverse Event Report? Yes
Is This A Product Problem Report? No
Device Operator Health Professional
Device MODEL NumberVHD
Was Device Available For Evaluation? No
Is The Reporter A Health Professional? Yes
Was the Report Sent to FDA? No
Distributor Facility Aware Date05/16/2001
Device Ageunknown
Event Location Hospital
Date Manufacturer Received05/15/2001
Was Device Evaluated By Manufacturer? Device Not Returned To Manufacturer
Is The Device Single Use? Yes
Is the Device an Implant? Yes
Is this an Explanted Device?
Type of Device Usage Initial

Patient TREATMENT DATA
Date Received: 06/08/2001 Patient Sequence Number: 1
#TreatmentTreatment Date
1,DARVOCET AND MOTRIN FOR PAIN.,

Database last updated on January 30, 2009

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