BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    RX CYTOLOGY BRUSH

    MDR report key: 2990103 · Received March 5, 2013

    Report

    Report Number
    3005099803-2013-01457
    Event Type
    Malfunction
    Date Received
    March 5, 2013
    Date of Event
    February 18, 2013
    Report Date
    February 19, 2013
    Manufacturer
    BOSTON SCIENTIFIC - SPENCER
    Product Code
    FDX
    PMA / PMN Number
    K930348
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    AZ, US
    Reporter Occupation
    PHYSICIAN

    Narratives

    Additional Manufacturer Narrative · 1

    VISUAL EVALUATION OF THE RETURNED DEVICE FOUND THAT THE PROXIMAL END OF THE HANDLE CANNULA WAS BENT AT THE THUMB RING. FUNCTIONAL EVALUATION FOUND THAT WHEN THE HANDLE WAS ACTUATED, THE BRUSH WOULD EXTEND AND RETRACT AND THE BRUSH FULLY RETRACTED INTO THE CATHETER. THE DISTANCE BETWEEN THE BOTTOM OF THE GROOVE AT THE DISTAL END OF THE CANNULA TO THE DISTAL END OF THE BRUSH WAS MEASURED AND FOUND TO MEET SPECIFICATION. IN ADDITION, THE WORKING LENGTH AND BRUSH EXTENSION DISTANCE WERE MEASURED AND FOUND TO MEET SPECIFICATION. THE BRUSH RETRACTED WITHOUT ISSUE ACCORDING TO SPECIFICATION. THEREFORE THE INVESTIGATION WAS UNABLE TO CONFIRM THE REPORTED COMPLAINT THAT THE BRUSH WOULD NOT RETRACT. A SEARCH OF THE COMPLAINT DATABASE REVEALED THAT NO OTHER COMPLAINTS EXIST FOR THE SPECIFIED LOT. THE DEVICE HISTORY RECORD REVIEW FOUND THE DEVICE MET ALL MANUFACTURING SPECIFICATIONS.

    Additional Manufacturer Narrative · 1

    (B)(4) FOR THE REPORTED EVENT: BRUSH WOULD NOT RETRACT COMPLETELY. THE DEVICE HAS BEEN RECEIVED FOR ANALYSIS. UPON COMPLETION OF THE FAILURE ANALYSIS OF THE COMPLAINT DEVICE, IF THERE IS ANY FURTHER RELEVANT INFORMATION FROM THAT REVIEW, A SUPPLEMENTAL MEDWATCH WILL BE FILED.

    Description of Event or Problem · 1

    NOTE: THIS REPORT PERTAINS TO ONE OF SEVEN RX CYTOLOGY BRUSH DEVICES USED DURING THE SAME PROCEDURE. (MANUFACTURER REPORTS # 3005099803-2013-01451, 3005099803-2013-01452, 3005099803-2013-01453, 3005099803-2013-01454, 3005099803-2013-01455, 3005099803-2013-01456, AND 3005099803-2013-01457). IT WAS REPORTED TO BOSTON SCIENTIFIC CORPORATION THAT SEVEN RX CYTOLOGY BRUSHES WERE USED DURING AN ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP) PROCEDURE PERFORMED ON (B)(6) 2013. ACCORDING TO THE COMPLAINANT, DURING PREPARATION OF EACH DEVICE, WHEN THE DEVICE WAS TESTED, THE BRUSH WOULD NOT FULLY RETRACT BACK INTO THE SHEATH. THIS EVENT TOOK PLACE OUTSIDE THE PATIENT. THE SAME EVENT TOOK PLACE FOR EACH OF THESE SEVEN RX CYTOLOGY BRUSHES USED IN THE PROCEDURE. THE PROCEDURE WAS COMPLETED WITH AN EIGHTH RX CYTOLOGY BRUSH. 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 FINE.

    Description of Event or Problem · 1

    NOTE: THIS REPORT PERTAINS TO ONE OF SEVEN RX CYTOLOGY BRUSH DEVICES USED DURING THE SAME PROCEDURE (MANUFACTURER REPORTS # 3005099803-2013-01451, 3005099803-2013-01452, 3005099803-2013-01453, 3005099803-2013-01454, 3005099803-2013-01455, 3005099803-2013-01456, AND 3005099803-2013-01457). IT WAS REPORTED TO BOSTON SCIENTIFIC CORPORATION THAT SEVEN RX CYTOLOGY BRUSHES WERE USED DURING AN ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP) PROCEDURE PERFORMED ON (B)(6) 2013. ACCORDING TO THE COMPLAINANT, DURING PREPARATION OF EACH DEVICE, WHEN THE DEVICE WAS TESTED, THE BRUSH WOULD NOT FULLY RETRACT BACK INTO THE SHEATH. THIS EVENT TOOK PLACE OUTSIDE THE PATIENT. THE SAME EVENT TOOK PLACE FOR EACH OF THESE SEVEN RX CYTOLOGY BRUSHES USED IN THE PROCEDURE. THE PROCEDURE WAS COMPLETED WITH AN EIGHTH RX CYTOLOGY BRUSH. 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 FINE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    94337 RX CYTOLOGY BRUSH ENDOSCOPIC CYTOLOGY BRUSH FDX BOSTON SCIENTIFIC - SPENCER M00545000 0015726913

    Patients

    Seq Age Sex Outcome Treatment
    1