-TACK¿ ENDOSCOPIC HELIX TACKING SYSTEM
Report
- Report Number
- 3006722112-2023-00230
- Event Type
- Malfunction
- Date Received
- December 7, 2023
- Date of Event
- January 28, 2022
- Report Date
- October 17, 2023
- Manufacturer
- APOLLO ENDOSURGERY, INC
- Product Code
- OCW
- UDI-DI
- 10811955020763
- PMA / PMN Number
- K201808
- Adverse Event
- Yes
- Report Source
- Manufacturer report
- Reporter Location
- US
- Reporter Occupation
- PHYSICIAN
- Health Professional
- Yes
Narratives
COMBINED MEDWATCH SUBMITTED TO THE FDA ON 07/DEC/2023. CLINICAL STUDY (B)(6). A REVIEW OF THE DEVICE LABELING NOTES THE FOLLOWING: THE CURRENT X-TACK¿ ENDOSCOPIC HELIX TACKING SYSTEM INSTRUCTIONS FOR USE (IFU) ADDRESSED THE KNOWN AND POTENTIAL EVENTS OF "BLEEDING, HOSPITALIZATION, MEDICATION, AND BLOOD TRANSFUSION " AS FOLLOWS: WARNINGS - THE DEVICE SHOULD NOT BE USED TO TREAT ACUTELY BLEEDING ULCERS, ULCERS WITH STIGMATA OF RECENT BLEEDING OR ANY ULCERS WITH A VISIBLE VESSEL. - DO NOT USE A DEVICE WHERE THE INTEGRITY OF THE STERILE PACKAGING HAS BEEN COMPROMISED OR IF THE DEVICE APPEARS DAMAGED. - ONLY PHYSICIANS POSSESSING SUFFICIENT SKILL AND EXPERIENCE IN SIMILAR OR THE SAME TECHNIQUES SHOULD PERFORM ENDOSCOPIC PROCEDURES. - CONTACT OF ELECTROSURGICAL COMPONENTS WITH OTHER COMPONENTS MAY RESULT IN INJURY TO THE PATIENT AND/OR OPERATOR AS WELL AS DAMAGE TO THE DEVICE AND/OR ENDOSCOPE. - VERIFY COMPATIBILITY OF ENDOSCOPE SIZE, ENDOSCOPIC INSTRUMENTS AND ACCESSORIES AND ENSURE PERFORMANCE IS NOT COMPROMISED. - ENSURE ENDOSCOPE IS CLEAN, DRY, AND FREE OF LUBRICANTS PRIOR TO DEVICE INSTALLATION. - ENSURE ALL ENDOSCOPIC SCOPES, INCLUDING SCOPE CHANNELS, ARE IN GOOD WORKING CONDITION PRIOR TO USE. - SUCTION OPERATION THROUGH ENDOSCOPE MAY BE SIGNIFICANTLY REDUCED WHEN THE SCOPE CHANNEL LINER IS IN PROPER POSITION. - DO NOT PUSH THROUGH OR PULL BACK ON A RETROFLEXED SCOPE WITH INSTALLED HELIX TACK. - APPLYING EXCESSIVE FORCE TO THE DISTAL END OF THE X-TACK¿ DEVICE COULD COMPRESS OR DAMAGE THE HELIX TACK WHEN INSTALLED. - DO NOT RETRACT DEVICE INTO SCOPE WHILST A HELIX TACK IS INSTALLED. - REUSE OR REPROCESSING OF THE X-TACK¿ SYSTEM COULD RESULT IN DEVICE MALFUNCTION, PRECAUTIONS - THE SYSTEM MAY ONLY BE USED IF PURCHASED FROM APOLLO ENDOSURGERY, INC. OR ONE OF ITS AUTHORIZED AGENTS. ADVERSE EVENTS POSSIBLE COMPLICATIONS THAT MAY RESULT FROM USING THE X-TACK¿ SYSTEM INCLUDE, BUT MAY NOT BE LIMITED TO: - PHARYNGITIS / SORE THROAT - NAUSEA AND / OR VOMITING - ABDOMINAL PAIN AND / OR BLOATING - HEMORRHAGE - HEMATOMA - CONVERSION TO LAPAROSCOPIC OR OPEN PROCEDURE - STRICTURE - INFECTION / SEPSIS - PHARYNGEAL, GASTRIC, COLONIC AND/OR ESOPHAGEAL PERFORATION - ESOPHAGEAL, GASTRIC, COLONIC AND/OR PHARYNGEAL LACERATION - INTRA-ABDOMINAL (HOLLOW OR SOLID) VISCERAL INJURY - ASPIRATION - WOUND DEHISCENCE - ACUTE INFLAMMATORY TISSUE REACTION - DEATH ADDITIONAL INFORMATION: THE DEVICE HAS NOT BEEN RETURNED FOR ANALYSIS. THE INVESTIGATOR DETERMINED A DEVICE HISTORY RECORD (DHR) REVIEW IS NOT POSSIBLE FOR THIS COMPLAINT, AS THE REPORTER NOTED THE DEVICE LOT NUMBER WAS UNAVAILABLE. DEVICE EVALUATION SUMMARY: ASSESSMENT OF THE DEVICE INVOLVED IN THIS COMPLAINT WAS NOT POSSIBLE, AND IT HAS NOT BEEN POSSIBLE TO DETERMINE THE ROOT CAUSE FOR THIS EVENT.
THIS REPORT WAS REPORT FROM A CLINICAL STUDY. ON THE FOLLOW UP VISIT THE PATIENT PRESENTED WITH BLEEDING. PATIENT WAS ADMITTED TO THE HOSPITAL WHERE SHE WAS HAD AND ENDOSCOPY PERFORMED AND IT WAS FOUND PATIENT WAS BLEEDING. THE PATIENT WAS GIVING MEDICATION AND BLOOD TRANSFUSION. SHE WAS DISCHARGED 4 DAYS AFTER BEING ADMITTED WITH NO CONCERNS.
Devices
| Seq | Brand | Generic | Product Code | Manufacturer | Model | Lot | UDI-DI |
|---|---|---|---|---|---|---|---|
| 197494 | -TACK¿ ENDOSCOPIC HELIX TACKING SYSTEM | ENDOSCOPIC HELIX TACKING SYSTEM | OCW | APOLLO ENDOSURGERY, INC | XTACK-160-H | 10811955020763 |
Patients
| Seq | Age | Sex | Outcome | Treatment |
|---|---|---|---|---|
| 1 | 79 YR | Female | Hospitalization| O |