FDA Adverse Event Malfunction Summary report: N

ULTRA ICE PLUS CATHETER

MDR report key: 19164022 · Received April 22, 2024

Report

Report Number
MW5154100
Event Type
Malfunction
Date Received
April 22, 2024
Date of Event
March 18, 2024
Report Date
April 19, 2024
Manufacturer
BOSTON SCIENTIFIC CORPORATION
Product Code
DXK
Product Problem
Yes
Report Source
Voluntary report
Reporter Location
MN, US
Reporter Occupation
UNKNOWN
Health Professional
*

Narratives

Description of Event or Problem · 0

DURING PAROXYSMAL ATRIAL FIBRILLATION PROCEDURE, AN AIR LEAK OCCURRED. THE SHEATH WAS INSERTED THROUGH THE RIGHT FEMORAL VEIN, THE NON- (B)(6) CATHETER (ULTRA ICE PLUS BOSTON SCIENTIFIC) WAS FLUSHED AND THEN INSERTED THROUGH THE SHEATH WITHOUT ANY NOTED RESISTANCE. WHEN ASPIRATING BLOOD, AIR WAS ASPIRATED INTO THE SYRINGE. PHYSICIAN FELT THAT THE HEMOSTASIS VALVE WAS LOOSE. THE SHEATH WAS REPLACED WITH ANOTHER OF THE SAME MODEL BUT AIR WAS STILL ASPIRATED. THE NON- (B)(6) CATHETER (ULTRA ICE PLUS BOSTON SCIENTIFIC) WAS REPLACED AND THE ISSUE WAS RESOLVED. THE PROCEDURE WAS COMPLETED WITH NO ADVERSE CONSEQUENCES TO THE PATIENT. THE DEVICE WAS REMOVED BEFORE THE AIR WAS INTRODUCED INTO THE PATIENT. FLUOROSCOPY WAS USED TO CONFIRM THAT NO AIR ENTERED THE PATIENT. THIS REPORT REFLECTS INFORMATION RECEIVED BY FDA IN THE FORM OF A NOTIFICATION PER 803.22 (B)(2).

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1070373 ULTRA ICE PLUS CATHETER ECHOCARDIOGRAPH DXK BOSTON SCIENTIFIC CORPORATION M00499120

Patients

Seq Age Sex Outcome Treatment
1 NA Unknown