FDA Adverse Event Malfunction Summary report: N

ZERO TIP

MDR report key: 19955443 · Received August 9, 2024

Report

Report Number
2124215-2024-48184
Event Type
Malfunction
Date Received
August 9, 2024
Date of Event
July 17, 2024
Report Date
December 4, 2024
Manufacturer
BOSTON SCIENTIFIC CORPORATION
Product Code
FFL
UDI-DI
08714729469643
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
HK
Reporter Occupation
PHYSICIAN
Health Professional
Yes

Narratives

Additional Manufacturer Narrative · 0

BLOCK A2: PATIENT'S EXACT AGE IS UNKNOWN; HOWEVER, IT WAS REPORTED THAT THE PATIENT WAS OVER THE AGE OF 18. BLOCK H6: IMDRF DEVICE CODE A0401 CAPTURES THE REPORTABLE EVENT OF BASKET WIRE BREAK.

Additional Manufacturer Narrative · 0

BLOCK A2: PATIENT'S EXACT AGE IS UNKNOWN; HOWEVER, IT WAS REPORTED THAT THE PATIENT WAS OVER THE AGE OF 18. BLOCK H2: ADDITIONAL INFORMATION: BLOCK B5 (DESCRIBE EVENT OR PROBLEM). BLOCK H6: IMDRF DEVICE CODE A0401 CAPTURES THE REPORTABLE EVENT OF BASKET WIRE BREAK.

Additional Manufacturer Narrative · 0

BLOCK A2: PATIENT'S EXACT AGE IS UNKNOWN; HOWEVER, IT WAS REPORTED THAT THE PATIENT WAS OVER THE AGE OF 18. BLOCK H6: IMDRF DEVICE CODE A0401 CAPTURES THE REPORTABLE EVENT OF BASKET WIRE BREAK. BLOCK H11: INVESTIGATION RESULTS THE RETURNED ZERO TIP BASKET WAS ANALYZED, AND A VISUAL EVALUATION NOTED THAT THE DEVICE RETURNED WITH THE BASKET ON ITS OPEN POSITION. IT WAS ALSO NOTED THAT THE HANDLE RETURNED IN GOOD CONDITION. MEDIA ANALYSIS SHOWS WITH THE PICTURE PROVIDED BY THE CUSTOMER THAT ONE OF THE BASKETS WAS BROKEN. MICROSCOPIC EXAMINATION WAS PERFORMED UNDER MAGNIFICATION, AND IT WAS POSSIBLE TO SEE THAT ONE OF THE BASKET WIRES WAS BROKEN AND WAS NOT FULLY DETACHED. FUNCTIONAL EXAMINATION WAS PERFORMED, AND THE HANDLE WAS ACTUATED. ADDITIONALLY, THE BASKET WAS ABLE TO OPEN AND CLOSE. WITH ALL THE AVAILABLE INFORMATION, BOSTON SCIENTIFIC CONCLUDES THAT THE REPORTED EVENT OF BASKET WIRE BREAK WAS CONFIRMED. BASED ON THE INVESTIGATION RESULTS THIS COULD BE RELATED TO HANDLING AND MANIPULATION OF THE DEVICE DURING PROCEDURE, IT IS PROBABLE THAT AN EXCESS OF FORCE APPLIED TO THE DEVICE SUCH AS OPERATIONAL FACTORS DURING THEIR USE COULD LEAD TO BREAK THE BASKET WIRE. THE DEVICE MEETS ALL MANUFACTURING SPECIFICATIONS REQUIRED AND PASSED ALL THE CONTROLS AND INSPECTIONS; NO ABNORMALITIES WERE REPORTED DURING THE ASSEMBLY PROCESS. TAKING ALL AVAILABLE INFORMATION INTO CONSIDERATION, THE MOST PROBABLE CAUSE OF THIS COMPLAINT IS ADVERSE EVENT RELATED TO PROCEDURE BECAUSE THE ADVERSE EVENT OCCURRED DURING THE PROCEDURE AND THE DEVICE HAD NO INFLUENCE ON THE EVENT.

Description of Event or Problem · 0

IT WAS REPORTED THAT A ZERO TIP BASKET DEVICE WAS USED DURING A URETEROSCOPIC LITHOTRIPSY (URSL) PROCEDURE. DURING THE PROCEDURE, THE BASKET GOT DAMAGED INSIDE THE PATIENT. REPORTEDLY, THEY WERE ABLE TO REMOVE THE DEVICE OUT OF PATIENT AND NO BASKET PIECE LEFT INSIDE THE PATIENT BODY. THE PROCEDURE WAS COMPLETED WITH ANOTHER OF THE SAME DEVICE WITH NO PATIENT COMPLICATIONS.

Description of Event or Problem · 0

IT WAS REPORTED THAT A ZERO TIP BASKET DEVICE WAS USED DURING A URETEROSCOPIC LITHOTRIPSY (URSL) PROCEDURE. DURING THE PROCEDURE, THE BASKET WIRE GOT DAMAGED AND BROKEN. ADDITIONALLY, THERE WAS NO PIECES OF THE DEVICE WAS LEFT IN THE PATIENT BODY. REPORTEDLY, THEY WERE ABLE TO REMOVE THE BASKET USING A HAND PIECE. THE PROCEDURE WAS COMPLETED WITH ANOTHER OF THE SAME DEVICE WITH NO PATIENT COMPLICATIONS.

Description of Event or Problem · 0

IT WAS REPORTED THAT A ZERO TIP BASKET DEVICE WAS USED DURING A URETEROSCOPIC LITHOTRIPSY (URSL) PROCEDURE. DURING THE PROCEDURE, THE BASKET WIRE GOT DAMAGED AND BROKEN. ADDITIONALLY, THERE WAS NO PIECES OF THE DEVICE WAS LEFT IN THE PATIENT BODY. REPORTEDLY, THEY WERE ABLE TO REMOVE THE BASKET USING A HAND PIECE. THE PROCEDURE WAS COMPLETED WITH ANOTHER OF THE SAME DEVICE WITH NO PATIENT COMPLICATIONS.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
2247077 ZERO TIP DISLODGER, STONE, BASKET, URETERAL, METAL FFL BOSTON SCIENTIFIC CORPORATION M0063901050 0033428215 08714729469643

Patients

Seq Age Sex Outcome Treatment
1 NA Male