FDA Adverse Event Malfunction Summary report: N

FUSION CYTOLOGY BRUSH

MDR report key: 20665263 · Received November 12, 2024

Report

Report Number
1037905-2024-00714
Event Type
Malfunction
Date Received
November 12, 2024
Date of Event
October 1, 2024
Report Date
December 12, 2024
Manufacturer
WILSON-COOK MEDICAL INC
Product Code
FDX
UDI-DI
10827002315256
Adverse Event
Yes
Product Problem
Yes
Report Source
Manufacturer report
Reporter Occupation
OTHER HEALTH CARE PROFESSIONAL
Health Professional
Yes

Narratives

Additional Manufacturer Narrative · 0

PMA/510(K): K192908. THE INVESTIGATION IS ON-GOING. A FOLLOW-UP EMDR WILL BE PROVIDED WITHIN 30 DAYS OF SUBMISSION OF THIS REPORT.

Additional Manufacturer Narrative · 0

INVESTIGATION EVALUATION: A PRODUCT EVALUATION WAS PERFORMED ONLY BY THE PICTURES PROVIDED IN RESPONSE TO THIS REPORT BECAUSE THE PRODUCT SAID TO BE INVOLVED WAS NOT PROVIDED TO COOK FOR EVALUATION. THE REPORT WAS CONFIRMED WITH THE PICTURES PROVIDED. THE FIRST PICTURE IS AN "INTACT CYTOLOGY BRUSH TO SEE THE DIFFERENCE" PROVIDED BY THE USER. THE SECOND PICTURE SHOWS BRUSH PORTION OF THE PRODUCT SAID TO BE INVOLVED, AND THE COIL SPRING HAS DETACHED. THE DETACHED COIL SPRING IS NOT IN THE PICTURE. A PICTURE OF THE LOT NUMBER WAS NOT PROVIDED. WITHOUT THE PRODUCT OR SUBSTANTIAL EVIDENCE TO CONTRADICT THE COMPLAINT, IT IS CONSIDERED CONFIRMED BASED SOLELY ON THE PHOTOS PROVIDED AND STATEMENTS DESCRIBING THE EVENT. THE DEVICE HISTORY RECORD FOR THE LOT NUMBER 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 PICTURES PROVIDED CONFIRMED THE REPORT. A CORRECTIVE ACTION (CAPA) HAS BEEN INITIATED TO REDUCE OCCURRENCES OF BRUSH TIP/COIL SPRING DETACHMENT FOR CYTOLOGY BRUSH DEVICES. THE PRODUCT SAID TO BE INVOLVED IS INCLUDED IN THE SCOPE OF THE CORRECTIVE ACTIONS. PRIOR TO DISTRIBUTION, ALL FUSION CYTOLOGY BRUSHES ARE SUBJECTED TO A VISUAL INSPECTION AND FUNCTIONAL TESTING TO ENSURE DEVICE INTEGRITY. A REVIEW OF THE POSSIBLE DEVICE HISTORY RECORDS CONFIRMED THAT THE LOTS 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. A CORRECTIVE ACTION HAS BEEN INITIATED IN AN EFFORT TO REDUCE OCCURRENCES OF THIS NATURE. THIS PRODUCT WAS MANUFACTURED INCLUDED IN THE SCOPE OF THIS CORRECTIVE ACTION. QUALITY ASSURANCE WILL CONTINUE TO MONITOR FOR COMPLAINT TRENDS AND REASSESS THE RISK ASSESSMENT RESULTS AS POST MARKET FEEDBACK CONTINUES TO BECOME AVAILABLE.

Additional Manufacturer Narrative · 0

INVESTIGATION EVALUATION: A PRODUCT EVALUATION WAS PERFORMED ONLY BY THE PICTURES PROVIDED IN RESPONSE TO THIS REPORT BECAUSE THE PRODUCT SAID TO BE INVOLVED WAS NOT PROVIDED TO COOK FOR EVALUATION. THE REPORT WAS CONFIRMED WITH THE PICTURES PROVIDED. THE FIRST PICTURE IS AN "INTACT CYTOLOGY BRUSH TO SEE THE DIFFERENCE" PROVIDED BY THE USER. THE SECOND PICTURE SHOWS BRUSH PORTION OF THE PRODUCT SAID TO BE INVOLVED, AND THE COIL SPRING HAS DETACHED. THE DETACHED COIL SPRING IS NOT IN THE PICTURE. A PICTURE OF THE LOT NUMBER WAS NOT PROVIDED. WITHOUT THE PRODUCT OR SUBSTANTIAL EVIDENCE TO CONTRADICT THE COMPLAINT, IT IS CONSIDERED CONFIRMED BASED SOLELY ON THE PHOTOS PROVIDED AND STATEMENTS DESCRIBING THE EVENT. THE DEVICE HISTORY RECORD FOR THE LOT NUMBER 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 PICTURES PROVIDED CONFIRMED THE REPORT. A CORRECTIVE ACTION (CAPA) HAS BEEN INITIATED TO REDUCE OCCURRENCES OF BRUSH TIP/COIL SPRING DETACHMENT FOR CYTOLOGY BRUSH DEVICES. THE PRODUCT SAID TO BE INVOLVED IS INCLUDED IN THE SCOPE OF THE CORRECTIVE ACTIONS. PRIOR TO DISTRIBUTION, ALL FUSION CYTOLOGY BRUSHES ARE SUBJECTED TO A VISUAL INSPECTION AND FUNCTIONAL TESTING TO ENSURE DEVICE INTEGRITY. A REVIEW OF THE POSSIBLE DEVICE HISTORY RECORDS CONFIRMED THAT THE LOTS SAID TO BE INVOLVED MET ALL MANUFACTURING REQUIREMENTS PRIOR TO SHIPMENT. CORRECTIVE ACTION: A CORRECTIVE ACTION (CAPA) WAS INITIATED TO FURTHER INVESTIGATE DEVICE FAILURE DUE TO BRUSH TIP/COIL SPRING DETACHMENT . THE PRODUCT SAID TO BE INVOLVED IS INCLUDED IN THE SCOPE OF THE CORRECTIVE ACTION. A REVIEW OF THE COMPLAINT HISTORY WAS CONDUCTED. BASED ON THIS REVIEW, THE LIKELIHOOD OF THIS TYPE OF REPORT IS RARE. QUALITY ASSURANCE WILL CONTINUE TO MONITOR FOR COMPLAINT TRENDS.

Description of Event or Problem · 0

DURING AN ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY, THE PHYSICIAN USED A COOK FUSION CYTOLOGY BRUSH. IT WAS REPORTED THAT A CYTOLOGY BRUSH WAS USED IN PROCEDURE AND AFTER PLACEMENT OF A PLASTIC STENT, AN X-RAY WAS DONE TO CONFIRM POSITION OF PLASTIC STENT. IT WAS NOTED THAT A VERY SMALL PIECE OF BRUSH TIP WAS MISSING [DETACHED]. A PHOTO OF THE DEVICE WAS PROVIDED AND THE DISTAL TIP IS DETACHED. AT THE TIME OF THIS REPORT, OUR ATTEMPTS TO COLLECT ADDITIONAL INFORMATION REGARDING PATIENT OUTCOME HAVE BEEN UNSUCCESSFUL. WHILE THE COMPLAINANT DID NOT SPECIFY IF THE PATIENT EXPERIENCED ANY ADVERSE EFFECTS OR HOW DETACHED DEVICE PORTION WAS RETRIEVED, THE INFORMATION ABLE TO BE COLLECTED DOES NOT REASONABLY SUGGEST THE PATIENT WAS ADVERSELY IMPACTED. ADDITIONAL ATTEMPTS TO GATHER THIS INFORMATION WILL BE MADE.

Description of Event or Problem · 0

DURING AN ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY, THE PHYSICIAN USED A COOK FUSION CYTOLOGY BRUSH. IT WAS REPORTED THAT A CYTOLOGY BRUSH WAS USED IN PROCEDURE AND AFTER PLACEMENT OF A PLASTIC STENT, AN X-RAY WAS DONE TO CONFIRM POSITION OF PLASTIC STENT. IT WAS NOTED THAT A VERY SMALL PIECE OF BRUSH TIP WAS MISSING [DETACHED]. A PHOTO OF THE DEVICE WAS PROVIDED AND THE DETACHED COIL SPRING IS NOT IN THE PICTURE. OUR ATTEMPTS TO COLLECT ADDITIONAL INFORMATION REGARDING PATIENT OUTCOME WERE UNSUCCESSFUL. THE COMPLAINANT STATED THAT THEY PLACED A STENT TO ENSURE THE PATIENT WAS ABLE TO DRAIN BILE, WHICH COULD INDICATE THAT THE DETACHED PORTION WAS LEFT TO PASS NATURALLY, THE INFORMATION ABLE TO BE COLLECTED DOES NOT REASONABLY SUGGEST THE PATIENT WAS ADVERSELY IMPACTED.

Description of Event or Problem · 0

DURING AN ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY, THE PHYSICIAN USED A COOK FUSION CYTOLOGY BRUSH. IT WAS REPORTED THAT A CYTOLOGY BRUSH WAS USED IN PROCEDURE AND AFTER PLACEMENT OF A PLASTIC STENT, AN X-RAY WAS DONE TO CONFIRM POSITION OF PLASTIC STENT. IT WAS NOTED THAT A VERY SMALL PIECE OF BRUSH TIP WAS MISSING [DETACHED]. A PHOTO OF THE DEVICE WAS PROVIDED AND THE DISTAL TIP IS DETACHED. THE DETACHED PORTION OF THE CYTOLOGY BRUSH TIP REMAINED IN THE PATIENT'S BILIARY DUCT. FURTHER ERCP WAS PERFORMED AND ATTEMPTED RETRIEVAL WAS UNSUCCESSFUL. A STENT WAS PLACED TO ENSURE THE PATIENT WAS ABLE TO DRAIN BILE.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1136056 FUSION CYTOLOGY BRUSH FDX ENDOSCOPIC CYTOLOGY BRUSH FDX WILSON-COOK MEDICAL INC G31525 W4794756 10827002315256

Patients

Seq Age Sex Outcome Treatment
1 NA Unknown Other UNKNOWN ENDOSCOPE