FDA Adverse Event Malfunction Summary report: N

JAGWIRE

MDR report key: 1171321 · Received September 17, 2008

Report

Report Number
3005099803-2008-04632
Event Type
Malfunction
Date Received
September 17, 2008
Report Date
August 19, 2008
Manufacturer
BOSTON SCIENTIFIC
Product Code
EZB
PMA / PMN Number
EXEMPT
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
BE
Reporter Occupation
PHYSICIAN

Narratives

Description of Event or Problem · 1

SAME CASE AS MFR REPORT# 3005099803-2008-04631. IT WAS REPORTED THAT DURING AN UNSPECIFIED BILIARY PROCEDURE, GUIDE WIRE COATING DETACHMENTS OCCURRED. THE STONES WERE LOCATED IN THE COMMON BILE DUCT (CBD). AT AN UNSPECIFIED TIME DURING THE PROCEDURE, IT WAS NOTED THAT THE 0.035 JAG PRECURSOR GUIDE WIRE WAS UNABLE TO BE WITHDRAWN FROM ANOTHER MANUFACTURER'S GUIDE CATHETER. IT WAS NOTED THAT SOME OF THE GUIDE WIRE'S COATING HAD DETACHED AND REMAINED INSIDE THE GUIDE CATHETER. IT WAS NOTED THAT THE CATHETER WAS A REUSABLE CATHETER WHICH HAD ALREADY BEEN USED. A SECOND 0.035 JAG PRECURSOR GUIDE WIRE WAS ADVANCED, HOWEVER, THE SAME ISSUE OCCURRED. IT WAS NOT KNOWN HOW THESE DEVICES WERE REMOVED. IT WAS NOTED THAT THE DAMAGED PORTION OF THE GUIDE WIRE REMAINED INSIDE THE CATHETER. NO PATIENT INJURIES OR COMPLICATIONS WERE REPORTED. THE PATIENT'S STATUS IS UNKNOWN.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1 JAGWIRE EZB BOSTON SCIENTIFIC M0055658011 11808372

Patients

Seq Age Sex Outcome Treatment
1 OLYMPUS ENDOSCOPE