FDA Adverse Event Malfunction Summary report: N

SPEEDBAND SUPERVIEW SUPER 7

MDR report key: 21011245 · Received December 24, 2024

Report

Report Number
3005099803-2024-06447
Event Type
Malfunction
Date Received
December 24, 2024
Date of Event
November 28, 2024
Report Date
January 30, 2025
Manufacturer
BOSTON SCIENTIFIC CORPORATION
Product Code
MND
UDI-DI
08714729201960
PMA / PMN Number
510K EXEMPT
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
CH
Reporter Occupation
PHYSICIAN
Health Professional
Yes

Narratives

Additional Manufacturer Narrative · 0

BLOCK E1 (INITIAL REPORTER FACILITY NAME): (B)(6) HOSPITAL. BLOCK H6: IMDRF DEVICE CODE A050501 CAPTURES THE REPORTABLE EVENT OF BANDS UNABLE TO DEPLOY.

Additional Manufacturer Narrative · 0

BLOCK E1 (INITIAL REPORTER FACILITY NAME): (B)(6). BLOCK H6: IMDRF DEVICE CODE A050501 CAPTURES THE REPORTABLE EVENT OF BANDS UNABLE TO DEPLOY. BLOCK H11: CORRECTION: BLOCK H6 (PATIENT CODES).

Additional Manufacturer Narrative · 0

BLOCK E1 (INITIAL REPORTER FACILITY NAME): (B)(6). BLOCK H6: IMDRF DEVICE CODE A050501 CAPTURES THE REPORTABLE EVENT OF BANDS UNABLE TO DEPLOY. BLOCK H11: THE RETURNED SPEEDBAND SUPERVIEW SUPER 7 WAS ANALYZED, AND A VISUAL EVALUATION NOTED THAT THE LIGATOR HOUSING WAS NOT RETURNED AND ONLY THE HANDLE AND THE IRRIGATION TUBE WERE RETURNED. THE HANDLE HAD MARKS OF THE TRIP WIRE INDICATING THAT IT WAS SECURED. NO PROBLEMS WITH THE DEVICE WERE NOTED. THE REPORTED EVENT OF BANDS UNABLE TO DEPLOY CANNOT BE CONFIRMED. UPON ANALYSIS ON THE RETURNED COMPONENT, THE HANDLE HAD MARKS OF THE TRIP WIRE INDICATING THAT IT WAS SECURED. BASED ON THE LIMITED INFORMATION AVAILABLE AND WITHOUT RETURNED DEVICE ANALYSIS, THE MOST PROBABLE ROOT CAUSE OF THE EVENT COULD NOT BE DETERMINED. THEREFORE, THE MOST PROBABLE ROOT CAUSE OF THIS COMPLAINT IS CAUSE NOT ESTABLISHED. A LABELING REVIEW WAS PERFORMED AND, FROM THE INFORMATION AVAILABLE, PER THE INSTRUCTIONS FOR USE (IFU) / PRODUCT LABEL, THE REPORTED ADVERSE EVENT "HEMORRHAGE, MINOR" IS A KNOWN INHERENT RISK AND IS DOCUMENTED IN THE DEVICE LABELING AND INSTRUCTIONS FOR USE (IFU) AND IT IS NOTED IN THE ADVERSE EVENTS SECTION.

Description of Event or Problem · 0

IT WAS REPORTED TO BOSTON SCIENTIFIC CORPORATION THAT A SPEEDBAND SUPERVIEW SUPER 7 WAS USED IN THE ESOPHAGUS DURING AN ESOPHAGEAL VARICEAL LIGATION PROCEDURE FOR ENDOSCOPIC TREATMENT OF ESOPHAGEAL VARICES PERFORMED ON (B)(6) 2024. DURING THE PROCEDURE, THE BANDS COULD NOT BE DEPLOYED ONTO THE VARIX, WHICH RESULTED TO RUPTURE OF THE VENOUS MASS AND BLEEDING. A SECOND SPEEDBAND SUPERVIEW SUPER 7 WAS THEN USED TO ADDRESS THE RUPTURE OF THE VENOUS MASS AND THE BLEEDING, WHICH WAS SUCCESSFULLY RESOLVED. THE PROCEDURE WAS COMPLETED WITH THE SECOND SPEEDBAND SUPERVIEW SUPER 7 DEVICE. IT WAS NOTED THAT NO DIFFICULTY WAS EXPERIENCED UPON SETTING UP THE DEVICE. THERE WERE NO PATIENT COMPLICATIONS REPORTED AS A RESULT OF THIS EVENT. THE PATIENT'S CONDITION AT THE CONCLUSION OF THE PROCEDURE WAS REPORTED TO BE STABLE.

Description of Event or Problem · 0

IT WAS REPORTED TO BOSTON SCIENTIFIC CORPORATION THAT A SPEEDBAND SUPERVIEW SUPER 7 WAS USED IN THE ESOPHAGUS DURING AN ESOPHAGEAL VARICEAL LIGATION PROCEDURE FOR ENDOSCOPIC TREATMENT OF ESOPHAGEAL VARICES PERFORMED ON (B)(6) 2024. DURING THE PROCEDURE, THE BANDS COULD NOT BE DEPLOYED ONTO THE VARIX, WHICH RESULTED TO RUPTURE OF THE VENOUS MASS AND BLEEDING. A SECOND SPEEDBAND SUPERVIEW SUPER 7 WAS THEN USED TO ADDRESS THE RUPTURE OF THE VENOUS MASS AND THE BLEEDING, WHICH WAS SUCCESSFULLY RESOLVED. THE PROCEDURE WAS COMPLETED WITH THE SECOND SPEEDBAND SUPERVIEW SUPER 7 DEVICE. IT WAS NOTED THAT NO DIFFICULTY WAS EXPERIENCED UPON SETTING UP THE DEVICE. THERE WERE NO PATIENT COMPLICATIONS REPORTED AS A RESULT OF THIS EVENT. THE PATIENT'S CONDITION AT THE CONCLUSION OF THE PROCEDURE WAS REPORTED TO BE STABLE.

Description of Event or Problem · 0

IT WAS REPORTED TO BOSTON SCIENTIFIC CORPORATION THAT A SPEEDBAND SUPERVIEW SUPER 7 WAS USED IN THE ESOPHAGUS DURING AN ESOPHAGEAL VARICEAL LIGATION PROCEDURE FOR ENDOSCOPIC TREATMENT OF ESOPHAGEAL VARICES PERFORMED ON (B)(6) 2024. DURING THE PROCEDURE, THE BANDS COULD NOT BE DEPLOYED ONTO THE VARIX, WHICH RESULTED TO RUPTURE OF THE VENOUS MASS AND BLEEDING. A SECOND SPEEDBAND SUPERVIEW SUPER 7 WAS THEN USED TO ADDRESS THE RUPTURE OF THE VENOUS MASS AND THE BLEEDING, WHICH WAS SUCCESSFULLY RESOLVED. THE PROCEDURE WAS COMPLETED WITH THE SECOND SPEEDBAND SUPERVIEW SUPER 7 DEVICE. IT WAS NOTED THAT NO DIFFICULTY WAS EXPERIENCED UPON SETTING UP THE DEVICE. THERE WERE NO PATIENT COMPLICATIONS REPORTED AS A RESULT OF THIS EVENT. THE PATIENT'S CONDITION AT THE CONCLUSION OF THE PROCEDURE WAS REPORTED TO BE STABLE.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
2509983 SPEEDBAND SUPERVIEW SUPER 7 LIGATOR, ESOPHAGEAL MND BOSTON SCIENTIFIC CORPORATION M00542251 0034188386 08714729201960

Patients

Seq Age Sex Outcome Treatment
1 56 YR Male