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Adverse Event Report

3M HEALTH CARE SARNS AND CDI PRODUCTS SARNS 8000 ROLLER PUMP, 115V CARDIOPULMONARY BYPASS ROLLER PUMP   back to search results
Model Number 98-0702-0647-3
Event Date 09/09/1997
Event Type  Injury   Patient Outcome  Required Intervention;
Manufacturer Narrative

In addition, the submission of the medical device report is required of device manufacturers by 21 cfr 803. Neither the submission of information by a manufacturer pursuant to this rule nor public release of such information, constitutes an admission that a device has malfunctioned or establishes the existence of any connection between a-product any any death or injury. The information in the medical device report is based primarily on information related by third party sources; the accuracy of their reports and veracity of the sources have not been confirmed by the reporting party. Any business information contained in this report, such as sales and production figures, are confidential information and should be treated as such.

 
Event Description

During the surgical procedure, the hospital experienced a number of power outages (due to thunderstorms). When the power was restored after one of the outages, the suction pump reportedly restarted itself in reverse. The perfusionist then stopped the suction pump. The hospital lost power two more times after this incident. This event did not repeat itself during the subsequent power outages. No patient injury has been reported as a result of this incident.

 
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Brand NameSARNS 8000 ROLLER PUMP, 115V
Type of DeviceCARDIOPULMONARY BYPASS ROLLER PUMP
Baseline Brand Name8000 ROLLER PUMP, 115 V
Baseline Generic NameHEART-LUNG MACHINE
Baseline Catalogue Number16402
Baseline Model Number98-0702-0647-3
Baseline Device Family8000 PERFUSION SYSTEM
Baseline Device 510(K) NumberK915193
Baseline Device PMA Number
Baseline Preamendment? No
Transitional? No
510(K) Exempt? No
Shelf Life(Months)NA
Date First Marketed02/20/1993
Manufacturer (Section F)
3M HEALTH CARE SARNS AND CDI PRODUCTS
6200 jackson rd.
ann arbor MI 48103 9300
Manufacturer (Section D)
3M HEALTH CARE SARNS AND CDI PRODUCTS
6200 jackson rd.
ann arbor MI 48103 9300
Manufacturer (Section G)
TERUMO CARDIOVASCULAR SYSTEMS CORP.
6200 jackson rd.
ann arbor MI 48103
Manufacturer Contact
steven arick
6200 jackson road
ann arbor , MI 48103
(734) 663 -4145
Device Event Key125204
MDR Report Key127956
Event Key120330
Report Number1828100-1997-00016
Device Sequence Number1
Product CodeDTQ
Report Source Manufacturer
Source Type Health Professional
Reporter Occupation Nurse
Type of Report Initial
Report Date 10/09/1997
1 Device Was Involved in the Event
1 Patient Was Involved in the Event
Date FDA Received10/09/1997
Is This An Adverse Event Report? No
Is This A Product Problem Report? Yes
Device Operator Health Professional
Device MODEL Number98-0702-0647-3
Device Catalogue Number16402
Was Device Available For Evaluation? Yes
Date Returned to Manufacturer09/15/1997
Is The Reporter A Health Professional? Yes
Was the Report Sent to FDA? No
Date Manufacturer Received09/09/1997
Was Device Evaluated By Manufacturer? Yes
Date Device Manufactured09/01/1996
Is The Device Single Use? No
Is the Device an Implant? No
Is this an Explanted Device?
Type of Device Usage Reuse

Database last updated on February 28, 2009

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