FDA Adverse Event Malfunction Summary report: N

6F10CM SW RADIAL

MDR report key: 12446722 · Received September 9, 2021

Report

Report Number
9616099-2021-04848
Event Type
Malfunction
Date Received
September 9, 2021
Date of Event
January 1, 1980
Report Date
September 9, 2021
Manufacturer
CORDIS CORPORATION
Product Code
DYB
PMA / PMN Number
K181592
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
NY, US
Reporter Occupation
OTHER HEALTH CARE PROFESSIONAL

Narratives

Additional Manufacturer Narrative · 1

AS REPORTED, THE HYDROPHILIC COATING OF A 6F 10CM TRANS-RADIAL RAIN SHEATH STRIPPED OFF AT THE DISTAL END UPON INSERTION INTO THE VESSEL DURING A DIAGNOSTIC PROCEDURE. THE PROCEDURE WAS SUCCESSFULLY COMPLETED AFTER SWITCHING TO A NON-CORDIS SHEATH. THE PRODUCT WAS STORED PER THE INSTRUCTIONS FOR USE (IFU), IN A CLIMATE-CONTROLLED AREA. THE DEVICE WAS STORED FOR ONE MONTH BEFORE USE. THERE WAS NO DAMAGE TO THE PACKAGING OF THE DEVICE. THE DEVICE WAS OPENED IN A STERILE FIELD. NO ANOMALIES WERE NOTED TO THE DEVICE AFTER REMOVAL FROM THE PACKAGE. THERE WAS NO DIFFICULTY EXPERIENCED DURING PREP OF THE DEVICE. THE DEVICE WAS WIPED WITH WET GAUZE AND HYDRATED BEFORE INSERTION. THE DEVICE WAS EXPOSED TO AIR FOR 15 MINUTES PRIOR TO ATTEMPTING TO INSERT INTO THE PATIENT. ADDITIONAL INFORMATION WAS REQUESTED; HOWEVER, THE INFORMATION WAS NOT OBTAINED. THERE WAS NO REPORTED PATIENT INJURY. THE DEVICE WAS NOT RETURNED FOR ANALYSIS. NO LOT NUMBER WAS PROVIDED THEREFORE A PRODUCT HISTORY RECORD (PHR) REVIEW COULD NOT BE GENERATED. THE REPORTED ¿COATING-SHEATHS-SEPARATED IN-PATIENT¿ WAS UNABLE TO BE CONFIRMED AS THE DEVICE WAS NOT RETURNED FOR ANALYSIS. ACCORDING TO THE IFU, WHICH IS NOT INTENDED AS A MITIGATION OF RISK, ¿CAREFULLY REMOVE CSI FROM PACKAGE USING STERILE TECHNIQUE. CAUTION: TO PREVENT DAMAGE WHILE REMOVING SHEATH FROM PACKAGE, GENTLY PULL UP THE SIDE PORT (AT THE SHEATH HUB) TO REMOVE FROM THE PACKAGE. INSPECT THE SYSTEM CONTENTS FOR ANY SIGNS OF DAMAGE; DO NOT USE IF ANY DAMAGE IS PRESENT. SOAK THE CSI IN STERILE HEPARINIZED SALINE OR SIMILAR ISOTONIC SOLUTION TO ACTIVATE THE HYDROPHILIC COATING. IF USING A HYDROPHILIC ACCESS WIRE, SOAK THE WIRE AS WELL TO ACTIVATE THE COATING.¿ ADDITIONALLY, THE IFU CAUTIONS USERS ¿IF RESISTANCE IS FELT UPON INSERTION OR WITHDRAWAL, INVESTIGATE THE CAUSE BEFORE CONTINUING.¿ AS NOT LOT NUMBER WAS PROVIDED A PHR COULD NOT BE GENERATED. THE ROOT CAUSE COULD NOT BE CONCLUSIVELY DETERMINED; HOWEVER, AN INCREASE IN COMPLAINTS FOR THIS ISSUE HAS BEEN IDENTIFIED AND COULD BE POSSIBLY RELATED TO THE MANUFACTURING PROCESS; THEREFORE, A RISK ASSESSMENT TO ADDRESS THIS ISSUE HAS BEEN INITIATED.

Description of Event or Problem · 1

AS REPORTED, THE HYDROPHILIC COATING OF A 6F 10CM TRANS-RADIAL RAIN SHEATH STRIPPED OFF AT THE DISTAL END UPON INSERTION INTO THE VESSEL DURING A DIAGNOSTIC PROCEDURE. THE PROCEDURE WAS SUCCESSFULLY COMPLETED AFTER SWITCHING TO A NON-CORDIS SHEATH. THERE WAS NO REPORTED PATIENT INJURY. THE PRODUCT WAS STORED PER THE INSTRUCTIONS FOR USE (IFU), IN A CLIMATE-CONTROLLED AREA. THE DEVICE WAS STORED FOR ONE MONTH BEFORE USE. THERE WAS NO DAMAGE TO THE PACKAGING OF THE DEVICE. THE DEVICE WAS OPENED IN A STERILE FIELD. NO ANOMALIES WERE NOTED TO THE DEVICE AFTER REMOVAL FROM THE PACKAGE. THERE WAS NO DIFFICULTY EXPERIENCED DURING PREP OF THE DEVICE. THE DEVICE WAS WIPED WITH WET GAUZE AND HYDRATED BEFORE INSERTION. THE DEVICE WAS EXPOSED TO AIR FOR 15 MINUTES PRIOR TO ATTEMPTING TO INSERT INTO THE PATIENT. THE DEVICE WILL NOT BE RETURNED FOR EVALUATION. ADDITIONAL INFORMATION WAS REQUESTED; HOWEVER, THE INFORMATION WAS NOT OBTAINED.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1344550 6F10CM SW RADIAL INTRODUCER, CATHETER DYB CORDIS CORPORATION 506610S UNK

Patients

Seq Age Sex Outcome Treatment
1