FDA Adverse Event Injury Summary report: N

OHICHO3

MDR report key: 15317655 · Received August 30, 2022

Report

Report Number
3002808904-2022-00010
Event Type
Injury
Date Received
August 30, 2022
Date of Event
June 28, 2022
Report Date
August 15, 2022
Manufacturer
KANEKA CORPORATION
Product Code
LIT
Adverse Event
Yes
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
CH
Reporter Occupation
PHYSICIAN
Health Professional
Yes

Narratives

Additional Manufacturer Narrative · 0

THE DEVICE HISTORY RECORDS (DHR) OF THE DEVICE CONCERNED WAS REVIEWED. THE PRODUCTION LOT, TO WHICH THE DEVICE CONCERNED BELONGS, PASSED ALL IN-PROCESS INSPECTIONS INCLUDING THE SHAFT-PRESSURIZED TEST AND THE BALLOON-WRAPPING TEST FOR EVERY PRODUCT, AND THE FINISHED PRODUCT INSPECTIONS INCLUDING THE SHAFT TENSILE STRENGTH TEST AND THE REPETITIVE BALLOON INFLATION/DEFLATION TEST ON REPRESENTATIVE SAMPLES BASED ON SAMPLING PLAN. NO NONCONFORMITY OR ABNORMALITY IN THE MANUFACTURING PROCESSES OF THE DEVICE CONCERNED WAS FOUND. PROBABLE CAUSE(S) AND OUR COMMENT: IT IS ASSUMED THAT THE BALLOON RUPTURED DUE TO CONTACT WITH A HARD LESION, ETC., AND THAT WHEN THE RUPTURED BALLOON WAS REMOVED, THE BULKY PORTION CAUGHT ON THE SHEATH, ETC., CAUSING DIFFICULTY IN REMOVAL.

Description of Event or Problem · 0

OHICHO3 IS AN OTW-TYPE PTA BALLOON CATHETER COMPATIBLE WITH 0.035 INCH GUIDEWIRE. OHICHO3 HAS NO APPROVAL IN USA. HOWEVER, WE INTEND TO REPORT THIS CASE AS THE EVENT OCCURRED ON THE SIMILAR DEVICE FOR "METACROSS OTW" (OTW TYPE PTA BALLOON DILATATION CATHETER, 0.035" GUIDEWIRE COMPATIBLE) IN US UNDER 510(K)# K152080". A BALLOON RUPTURE OCCURRED DURING 3 TO 5 DILATATIONS PER SITE, EACH DILATATION LASTING 60 TO 180 SECONDS AT A PRESSURE OF 22 ATM. ATTEMPTS TO REMOVE THE DEVICE WERE UNSUCCESSFUL.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
134178 OHICHO3 OHICHO3, PRODUCT CODE: LIT LIT KANEKA CORPORATION SR021096

Patients

Seq Age Sex Outcome Treatment
1 70 YR Male Other