BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    MICROPUNCTURE TRANSITIONLESS STIFFENED CANNULA ACCESS SET

    MDR report key: 7399352 · Received April 5, 2018

    Report

    Report Number
    1820334-2018-00910
    Event Type
    Malfunction
    Date Received
    April 5, 2018
    Date of Event
    March 23, 2018
    Report Date
    May 7, 2018
    Manufacturer
    COOK INC
    Product Code
    DYB
    UDI-DI
    00827002355507
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    FL, US
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 0

    INVESTIGATION ¿ EVALUATION: A REVIEW OF THE DIMENSIONAL VERIFICATION, COMPLAINT HISTORY, DEVICE HISTORY RECORD, DRAWING, QUALITY CONTROL, AND A VISUAL INSPECTION OF THE RETURNED DEVICE WERE CONDUCTED DURING THE INVESTIGATION. THE VISUAL INSPECTION OF THE RETURNED DEVICE CONFIRMED THAT THE OUTER CATHETER DETACHED FROM THE HUB AT THE PROXIMAL END OF THE DEVICE. SIGNIFICANT STRETCHING OF THE SEPARATED OUTER CATHETER WAS NOTED. A KINK WAS ALSO NOTED A DISTANCE OF 6.9 CM FORM THE DISTAL TIP OF THE OUTER CATHETER. ADDITIONALLY, A DOCUMENT BASED INVESTIGATION EVALUATION WAS PERFORMED. THERE IS NO EVIDENCE TO SUGGEST THE PRODUCT WAS NOT MADE TO SPECIFICATIONS. A REVIEW OF THE DEVICE HISTORY RECORD SHOWED NO NONCONFORMING EVENTS WHICH COULD CONTRIBUTE TO THIS FAILURE MODE. IT SHOULD BE NOTED THERE WERE NO OTHER REPORTED COMPLAINTS FOR THIS LOT NUMBER. BASED ON THE INFORMATION PROVIDED, THE EXAMINATION OF THE RETURNED PRODUCT, AND THE RESULTS OF OUR INVESTIGATION, A DEFINITIVE ROOT CAUSE COULD NOT BE DETERMINED. WE WILL CONTINUE TO MONITOR FOR SIMILAR COMPLAINTS. PER THE QUALITY ENGINEERING RISK ASSESSMENT, NO FURTHER ACTION IS REQUIRED.

    Additional Manufacturer Narrative · 1

    (B)(4). PMA/510(K) NUMBER = K133114. THIS REPORT INCLUDES INFORMATION KNOWN AT THIS TIME. A FOLLOW-UP REPORT WILL BE SUBMITTED SHOULD ADDITIONAL RELEVANT INFORMATION BECOME AVAILABLE.

    Description of Event or Problem · 1

    IT WAS REPORTED THAT DURING A LEFT LOWER EXTREMITY ANGIOGRAM WITH ARTERIOVENOUS FISTULA (AVF) EMBOLIZATION, THE MICROPUNCTURE TRANSITIONLESS STIFFENED CANNULA ACCESS SET SEPARATED FROM THE HUB; THEREFORE, WAS NOT USED. THE PROCEDURE WAS SUCCESSFULLY COMPLETED USING ANOTHER MICROPUNCTURE TRANSITIONLESS STIFFENED CANNULA ACCESS SET. A SECTION OF THE DEVICE DID NOT REMAIN INSIDE THE PATIENT¿S BODY. THE PATIENT DID NOT REQUIRE ANY ADDITIONAL PROCEDURES DUE TO THIS OCCURRENCE. ACCORDING TO THE INITIAL REPORTER, THE PATIENT DID NOT EXPERIENCE ANY ADVERSE EFFECTS DUE TO THIS OCCURRENCE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    243130 MICROPUNCTURE TRANSITIONLESS STIFFENED CANNULA ACCESS SET DYB INTRODUCER, CATHETER DYB COOK INC 00827002355507

    Patients

    Seq Age Sex Outcome Treatment
    1 80 YR