FDA Adverse Event Malfunction Summary report: N

ACUSNARE POLYPECTOMY SNARE SOFT

MDR report key: 19067384 · Received April 8, 2024

Report

Report Number
1037905-2024-00203
Event Type
Malfunction
Date Received
April 8, 2024
Date of Event
March 15, 2024
Report Date
April 8, 2024
Manufacturer
WILSON-COOK MEDICAL INC
Product Code
FDI
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
KS, US
Reporter Occupation
OTHER HEALTH CARE PROFESSIONAL
Health Professional
Yes

Narratives

Additional Manufacturer Narrative · 0

CONTINUED: SECTION G: 510K: K173673. INVESTIGATION EVALUATION: THE PRODUCTS SAID TO BE INVOLVED WERE RETURNED IN A BIOHAZARD BAG WITH TWO SMALLER BIOHAZARD BAGS INSIDE. NO LOT NUMBER WAS RETURNED WITH THE DEVICES. DEVICE #1: OUR LABORATORY EVALUATION OF THE PRODUCT SAID TO BE INVOLVED CONFIRMED THE REPORT. THE DEVICE RETURNED WITH THE SNARE HEAD FULLY RETRACTED INTO THE SHEATH. A VISUAL INSPECTION IDENTIFIED KINKING FROM THE PROXIMAL END OF THE HANDLE TO 1.9CM. THE DEVICE WAS FUNCTION TESTED AND THE SNARE ADVANCED/RETRACTED WHEN THE HANDLE WAS MANIPULATED WITH SOME RESISTANCE. NO OTHER ANOMALIES WERE DETECTED WITH THE DEVICE. DEVICE #2: OUR LABORATORY EVALUATION OF THE PRODUCT SAID TO BE INVOLVED CONFIRMED THE REPORT. THE DEVICE RETURNED WITH THE SNARE HEAD FULLY RETRACTED INTO THE SHEATH. A VISUAL INSPECTION IDENTIFIED KINKING FROM THE PROXIMAL END OF THE HANDLE TO 3.0CM. THE DEVICE WAS FUNCTION TESTED AND THE SNARE ADVANCED/RETRACTED WHEN THE HANDLE WAS MANIPULATED WITH SIGNIFICANT RESISTANCE. NO OTHER ANOMALIES WERE DETECTED WITH THE DEVICE. THE DEVICE HISTORY RECORDS FOR THE LOT NUMBERS SAID TO BE INVOLVED WAS REVIEWED. A DISCREPANCY OR ANOMALY WAS NOT OBSERVED WITH THE PRODUCT THAT WAS RELEASED FOR DISTRIBUTION. INVESTIGATION CONCLUSION: OUR EVALUATION OF THE RETURNED DEVICES CONFIRMED THE REPORT. A DEFINITIVE CAUSE FOR THIS OBSERVATION COULD NOT BE DETERMINED BECAUSE THE ACTUAL USE CONDITIONS COULD NOT BE DUPLICATED IN THE LABORATORY SETTING. DUE TO A VARIETY OF CLINICAL CONDITIONS SUCH AS PATIENT ANATOMY, ENDOSCOPE POSITION OR PROGRESSION OF DISEASE STATE, WE COULD NOT REPRODUCE THE ACTUAL CONDITIONS OF PRODUCT USAGE DURING OUR LABORATORY ANALYSIS. THIS LIMITS OUR ABILITY TO CONCLUSIVELY DETERMINE A CAUSE. PRIOR TO DISTRIBUTION, ALL ACUSNARE POLYPECTOMY SNARES ARE SUBJECTED TO A VISUAL INSPECTION AND FUNCTIONAL TESTING TO ENSURE DEVICE INTEGRITY. A REVIEW OF THE DEVICE HISTORY RECORD CONFIRMED THAT THE LOT SAID TO BE INVOLVED MET ALL MANUFACTURING REQUIREMENTS PRIOR TO SHIPMENT. CORRECTIVE ACTION: A REVIEW OF THE COMPLAINT HISTORY WAS CONDUCTED. THE LIKELIHOOD OF OCCURRENCE IS CONSIDERED RARE. CORRECTIVE ACTION IS NOT WARRANTED AT THIS TIME BASED ON THE QUALITY ENGINEERING RISK ASSESSMENT. QUALITY ASSURANCE WILL CONTINUE TO MONITOR FOR COMPLAINT TRENDS AND REASSESS THE RISK ASSESSMENT RESULTS AS POST MARKET FEEDBACK CONTINUES TO BECOME AVAILABLE.

Description of Event or Problem · 0

DURING A COLONOSCOPY WITH POLYPECTOMY, THE PHYSICIAN USED A COOK ACUSNARE POLYPECTOMY SNARE, SOFT. IT WAS REPORTED THAT THE POLYP STALK WAS VERY HARD, AND THEY WERE UNABLE TO CUT THRU THE STALK. SEVERAL SNARES WERE USED AS THEY STATED THEY THOUGHT THE SNARE WAS MELTING THE PLASTIC SHEATH AT THE BASE OF THE HANDLE BUT IT WAS DETERMINED THAT IT WAS NOT MELTING BUT KINKING DUE TO THE TENSION PLACED ON THE HANDLE AND THE WIRE NOT CUTTING THRU THE POLYP STALK. THEY WERE ABLE TO SUCCESSFULLY REMOVE THE POLYP WITH ANOTHER OF THE SAME DEVICE. A SECTION OF THE DEVICE DID NOT REMAIN INSIDE THE PATIENT¿S BODY. THE PATIENT DID NOT REQUIRE ANY ADDITIONAL PROCEDURES DUE TO THIS OCCURRENCE. ACCORDING TO THE INITIAL REPORTER, THE PATIENT DID NOT EXPERIENCE ANY ADVERSE EFFECTS DUE TO THIS OCCURRENCE.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
143812 ACUSNARE POLYPECTOMY SNARE SOFT FDI, SNARE, FLEXIBLE FDI WILSON-COOK MEDICAL INC UNKNOWN

Patients

Seq Age Sex Outcome Treatment
1 NA Unknown ENDOSCOPE - UNKNOWN MAKE OR MODEL