FDA Adverse Event Malfunction Summary report: N

COOK CELECT® PLATINUM NAVALIGN JUGULAR VENA CAVA FILTER SET

MDR report key: 20664461 · Received November 12, 2024

Report

Report Number
3002808486-2024-00240
Event Type
Malfunction
Date Received
November 12, 2024
Date of Event
October 15, 2024
Report Date
January 14, 2025
Manufacturer
WILLIAM COOK EUROPE
Product Code
DTK
UDI-DI
10827002343099
Adverse Event
Yes
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
MD, US
Reporter Occupation
OTHER
Health Professional
N

Narratives

Additional Manufacturer Narrative · 0

MANUFACTURERS REF# (B)(4). G4) 510(K): K233680. INVESTIGATION IS STILL IN PROGRESS. THIS REPORT IS REQUIRED BY THE FDA UNDER 21CFR PART 803. THIS REPORT IS BASED ON UNCONFIRMED INFORMATION SUBMITTED BY OTHERS. NEITHER THE SUBMISSION OF THIS REPORT NOR ANY STATEMENT MADE IN IT IS INTENDED TO BE AN ADMISSION THAT ANY COOK DEVICE IS DEFECTIVE OR MALFUNCTIONED; THAT A DEATH OR SERIOUS INJURY OCCURRED; OR THAT ANY COOK DEVICE CAUSED OR CONTRIBUTED TO; OR IS LIKELY TO CAUSE OR CONTRIBUTE TO A DEATH OR SERIOUS INJURY IF A MALFUNCTION OCCURRED.

Additional Manufacturer Narrative · 0

MANUFACTURERS REF# (B)(4). BLANK FIELDS ON THIS FORM INDICATE THE INFORMATION IS UNKNOWN OR UNAVAILABLE. G4) PMA/510(K): K233680. SUMMARY OF INVESTIGATIONAL FINDINGS: ONE FILTER LEG WOULD NOT EXPAND DURING DEPLOYMENT FROM JUGULAR APPROACH. THE DEVICE WAS REMOVED AND ANOTHER FILTER WAS SUCCESSFULLY PLACED. THE UNLOCKED JUGULAR INTRODUCER WITH LOADED FILTER WAS RETURNED. THE GRASPING HOOK HAD KINKED, BUT THE FILTER COULD BE ADVANCED AND RELEASED WITHOUT DIFFICULTY. ONE OF THE PRIMARY FILTER LEGS WAS SLIGHTLY OUT OF SHAPE. BASED ON THE INVESTIGATION FINDINGS THE EXACT REASON FOR A PRIMARY FILTER LEG TO NOT FULLY EXPAND CANNOT BE DETERMINED, BUT THE FILTER LEGS MAY BE SOMEHOW OBSTRUCTED FROM FULLY EXPANDING IF THE FILTER IS DEPLOYED IN A THROMBUS, OR IF THE FILTER LEGS ARE CAUGHT IN A CLOT. HOWEVER, THE DAMAGED GRASPING HOOK MAY INDICATE DIFFICULTIES IN RE-SHEATHING THE FILTER, THUS SUGGESTING THE FILTER HAD BEEN PLACED IN AN INCORRECT POSITION OR ORIENTATION PRIOR TO RELEASE, BUT THIS IS PURE SPECULATION SINCE NO IMAGING WAS PROVIDED. THERE ARE ADEQUATE CONTROLS IN PLACE TO ENSURE THE DEVICE WAS MANUFACTURED TO SPECIFICATIONS. IT IS ASSESSED THAT BECAUSE NO NON-CONFORMANCES WERE DETECTED THERE IS EVIDENCE THAT THE DEVICE WAS MANUFACTURED IN COMPLIANCE WITH PROCEDURES AND ACCORDING TO SPECIFICATIONS. IN ADDITION, NO OTHER LOT RELATED COMPLAINTS HAVE BEEN RECEIVED FROM THE FIELD. IT IS THEREFORE CONCLUDED THAT THERE IS NO EVIDENCE THAT NON-CONFORMING PRODUCT EXISTS IN HOUSE OR IN FIELD. COOK MEDICAL WILL CONTINUE TO MONITOR FOR SIMILAR EVENTS. THIS REPORT IS REQUIRED BY THE FDA UNDER 21CFR PART 803. THIS REPORT IS BASED ON UNCONFIRMED INFORMATION SUBMITTED BY OTHERS. NEITHER THE SUBMISSION OF THIS REPORT NOR ANY STATEMENT MADE IN IT IS INTENDED TO BE AN ADMISSION THAT ANY COOK DEVICE IS DEFECTIVE OR MALFUNCTIONED; THAT A DEATH OR SERIOUS INJURY OCCURRED; OR THAT ANY COOK DEVICE CAUSED OR CONTRIBUTED TO; OR IS LIKELY TO CAUSE OR CONTRIBUTE TO A DEATH OR SERIOUS INJURY IF A MALFUNCTION OCCURRED.

Description of Event or Problem · 0

DESCRIPTION OF EVENT ACCORDING TO INITIAL REPORTER: DURING THE DEPLOYMENT THE PHYSICIAN NOTICED ONE FOOT OF THE FILTER WOULD NOT EXPAND. DECISION WAS MADE TO REMOVE THE DEFECTIVE DEVICE. A SECOND FILTER WAS OPENED AND DEPLOYED WITHOUT ISSUE. PATIENT OUTCOME: ACCORDING TO THE INITIAL REPORTER, THE PATIENT DID NOT EXPERIENCE ANY ADVERSE EFFECTS DUE TO THIS OCCURRENCE.

Description of Event or Problem · 0

NO ADDITIONAL INFORMATION REGARDING THE PATIENT AND/OR EVENT HAS BEEN RECEIVED SINCE THE PREVIOUS MEDWATCH REPORT WAS SENT.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1643621 COOK CELECT® PLATINUM NAVALIGN JUGULAR VENA CAVA FILTER SET DTK FILTER, INTRAVASCULAR, CARDIOVASCULAR DTK WILLIAM COOK EUROPE G34309 E4330380 10827002343099

Patients

Seq Age Sex Outcome Treatment
1 NA Unknown Required Intervention