FDA Adverse Event Death Summary report: N

EXTRACTOR PRO

MDR report key: 19354116 · Received May 20, 2024

Report

Report Number
3005099803-2024-02356
Event Type
Death
Date Received
May 20, 2024
Date of Event
April 17, 2024
Report Date
June 18, 2024
Manufacturer
BOSTON SCIENTIFIC CORPORATION
Product Code
FGE
Adverse Event
Yes
Report Source
Manufacturer report
Reporter Location
TW
Reporter Occupation
PHYSICIAN
Health Professional
Yes

Narratives

Additional Manufacturer Narrative · 0

BLOCK D4, H4: THE COMPLAINANT WAS UNABLE TO PROVIDE THE UPN AND LOT NUMBER. THEREFORE, THE MANUFACTURE AND EXPIRATION DATES ARE UNKNOWN. BLOCK H6: IMDRF PATIENT CODE E0306 IS BEING USED TO CAPTURE THE REPORTABLE EVENT OF SEPSIS. IMDRF PATIENT CODE E233605 IS BEING USED TO CAPTURE THE REPORTABLE EVENT OF SEPTIC SHOCK. IMDRF IMPACT CODE F2303 IS BEING USED TO CAPTURE THE REPORTABLE EVENT OF MEDICATION REQUIRED. IMDRF IMPACT CODE F02 IS BEING USED TO CAPTURE THE REPORTABLE EVENT OF DEATH. IMDRF IMPACT CODE F2301 CAPTURES THE REPORTABLE EVENT OF ADDITIONAL DEVICE REQUIRED.

Additional Manufacturer Narrative · 0

H4: THE COMPLAINANT WAS UNABLE TO PROVIDE THE UPN AND LOT NUMBER. THEREFORE, THE MANUFACTURE AND EXPIRATION DATES ARE UNKNOWN. BLOCK H6: IMDRF PATIENT CODE E0306 IS BEING USED TO CAPTURE THE REPORTABLE EVENT OF SEPSIS. IMDRF PATIENT CODE E233605 IS BEING USED TO CAPTURE THE REPORTABLE EVENT OF SEPTIC SHOCK. IMDRF IMPACT CODE F2303 IS BEING USED TO CAPTURE THE REPORTABLE EVENT OF MEDICATION REQUIRED. IMDRF IMPACT CODE F02 IS BEING USED TO CAPTURE THE REPORTABLE EVENT OF DEATH.

Description of Event or Problem · 0

IT WAS REPORTED TO BOSTON SCIENTIFIC CORPORATION THAT AN EXTRACTOR PRO RETRIEVAL BALLOON WAS USED IN THE BILIARY TREE DURING AN ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP) PROCEDURE PERFORMED FOR THE DIAGNOSIS OF BILIARY STRICTURE ON (B)(6) 2024. DURING THE PROCEDURE, THE SPYSCOPE DS II WAS USED TOGETHER WITH A SPYBITE BIOPSY FORCEPS AND AN EXTRACTOR PRO TO REMOVE THE STONES. THE PROCEDURE WAS COMPLETED WITH THIS DEVICE. THE PHYSICIAN REPORTED THAT THE PATIENT DEVELOPED SEPSIS ON (B)(6) 2024, AND WAS UNDER MEDICINE CONTROL. ON (B)(6) 2024, THE PATIENT HAD SEPTIC SHOCK WHICH LED TO DEATH ON THE SAME DAY. REPORTEDLY, IT WAS UNKNOWN IF THE PATIENT HAS ANY CO-MORBIDITIES THAT COULD HAVE CONTRIBUTED TO THE EVENT, HOWEVER, THE RESULT OF THE BIOPSY WAS POSITIVE CHOLANGIOCARCINOMA. CORRECTION: IN THE PHYSICIAN'S ASSESSMENT, THE SPYSCOPE DS II, SPYBITE BIOPSY FORCEPS, AND THE EXTRACTOR PRO DID NOT CONTRIBUTE TO THE PATIENT'S SEPSIS. ADDITIONAL INFORMATION WAS RECEIVED ON MAY 24, 2024: IT WAS REPORTED THAT A SPHINCTEROTOMY WAS PERFORMED ON THE PATIENT FROM A DIFFERENT HEALTH CARE FACILITY PRIOR TO THE ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP) PROCEDURE USING THE SPYSCOPE DS II. THE 7FR ADVANIX STENT THAT WAS IMPLANTED WAS REMOVED TO PROCEED WITH THE SPYGLASS PROCEDURE AND A 10FR/7 ADVANIX RX STENT WAS THEN PLACED AFTER TO COMPLETE THE PROCEDURE.

Description of Event or Problem · 0

IT WAS REPORTED TO BOSTON SCIENTIFIC CORPORATION THAT AN EXTRACTOR PRO RETRIEVAL BALLOON WAS USED IN THE BILIARY TREE DURING AN ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP) PROCEDURE PERFORMED FOR THE DIAGNOSIS OF BILIARY STRICTURE ON (B)(6) 2024. DURING THE PROCEDURE, THE SPYSCOPE DS II WAS USED TOGETHER WITH A SPYBITE BIOPSY FORCEPS AND AN EXTRACTOR PRO TO REMOVE THE STONES. THE PROCEDURE WAS COMPLETED WITH THIS DEVICE. THE PHYSICIAN REPORTED THAT THE PATIENT DEVELOPED SEPSIS ON (B)(6) 2024, AND WAS UNDER MEDICINE CONTROL. ON (B)(6) 2024, THE PATIENT HAD SEPTIC SHOCK WHICH LED TO DEATH ON THE SAME DAY. REPORTEDLY, IT WAS UNKNOWN IF THE PATIENT HAD ANY CO-MORBIDITIES THAT COULD HAVE CONTRIBUTED TO THE EVENT, HOWEVER, THE RESULT OF THE BIOPSY WAS POSITIVE FOR CHOLANGIOCARCINOMA.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1608432 EXTRACTOR PRO CATHETER, BILIARY, DIAGNOSTIC FGE BOSTON SCIENTIFIC CORPORATION

Patients

Seq Age Sex Outcome Treatment
1 NA Unknown Death| O