FDA Adverse Event Injury Summary report: N

ECHOTIP PROCORE HIGH DEFINITION ULTRASOUND BIOPSY NEEDLE

MDR report key: 8019855 · Received October 30, 2018

Report

Report Number
3001845648-2018-00504
Event Type
Injury
Date Received
October 30, 2018
Date of Event
July 9, 2018
Report Date
November 27, 2018
Manufacturer
COOK IRELAND LTD
Product Code
FCG
UDI-DI
00827002535855
Adverse Event
Yes
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
MX
Reporter Occupation
OTHER HEALTH CARE PROFESSIONAL

Narratives

Additional Manufacturer Narrative · 0

510 (K) NUMBER: K142688. COOK IRELAND LTD (MANUFACTURER) IS SUBMITTING THIS REPORT ON BEHALF OF COOK MEDICAL INCORPORATED (CMI)(IMPORTER). EXEMPTION NUMBER: E2016031. INFORMATION PERTAINING TO SECTION G. 1 AS FOLLOWS: IMPORTER SITE CONTACT AND ADDRESS: (B)(4) COOK MEDICAL INCORPORATED (CMI) 1025 ACUFF ROAD P.O BOX 4195 BLOOMINGTON INDIANA 47402-4195. IMPORTER SITE ESTABLISHMENT REGISTRATION NUMBER: 3005580113. INVESTIGATION IS STILL PENDING. A FOLLOW UP MDR WILL BE SUBMITTED TO INCLUDE THE INVESTIGATION CONCLUSIONS.

Additional Manufacturer Narrative · 0

510 (K) NUMBER; K142688 COOK (B)(4) LTD (MANUFACTURER) IS SUBMITTING THIS REPORT ON BEHALF OF COOK MEDICAL INCORPORATED (CMI)(IMPORTER). EXEMPTION NUMBER: E2016031 INFORMATION PERTAINING TO SECTION G. 1 AS FOLLOWS: IMPORTER SITE CONTACT AND ADDRESS: (B)(6) COOK MEDICAL INCORPORATED (CMI) 1025 ACUFF ROAD P.O BOX 4195 BLOOMINGTON INDIANA 47402-4195 IMPORTER SITE ESTABLISHMENT REGISTRATION NUMBER: 3005580113 INVESTIGATION IS STILL PENDING. A FOLLOW UP MDR WILL BE SUBMITTED TO INCLUDE THE INVESTIGATION CONCLUSIONS.

Additional Manufacturer Narrative · 0

510 (K) NUMBER; K142688 . COOK IRELAND LTD (MANUFACTURER) IS SUBMITTING THIS REPORT ON BEHALF OF COOK MEDICAL INCORPORATED (CMI)(IMPORTER). EXEMPTION NUMBER: E2016031. INFORMATION PERTAINING TO SECTION G. 1 AS FOLLOWS: IMPORTER SITE CONTACT AND ADDRESS: (B)(4). COOK MEDICAL INCORPORATED (CMI) 1025 ACUFF ROAD P.O BOX 4195 BLOOMINGTON INDIANA 47402-4195. IMPORTER SITE ESTABLISHMENT REGISTRATION NUMBER: 3005580113. THE TWO DEVICES RELATED TO THIS OCCURRENCE UNDERWENT A LABORATORY EVALUATION. THE NEEDLE TIPS ON BOTH DEVICES WERE FOUND TO BE BENT. PRIOR TO DISTRIBUTION, ALL ECHO-HD-19-C DEVICES ARE SUBJECTED TO FUNCTIONAL CHECKS AND VISUAL INSPECTION TO ENSURE DEVICE INTEGRITY. THESE INSPECTIONS AND FUNCTIONAL CHECKS ARE OUTLINED IN INTERNAL PROCEDURES IN PLACE AT CIRL. A REVIEW OF THE MANUFACTURING RECORDS FOR ECHO-HD-19-C OF LOT NUMBER C1427326 DID NOT REVEAL ANY DISCREPANCIES THAT COULD HAVE CONTRIBUTED TO THIS COMPLAINT ISSUE. THE REVIEW OF RELEVANT MANUFACTURING RECORDS, CONFIRMS THE FAILURE MODE HAS NOT PREVIOUSLY OCCURRED WITH THE CURRENT LOT NUMBER. BASED ON THE INFORMATION AVAILABLE TO DATE, THERE IS NO EVIDENCE TO SUGGEST THAT THERE ARE ANY MANUFACTURING ISSUES ASSOCIATED WITH LOT NUMBER C1427326. THE NOTES SECTION OF THE INSTRUCTIONS FOR USE, WHICH ACCOMPANIES THIS DEVICE INSTRUCTS THE USER TO INSPECT THE DEVICE PRIOR TO USE : "VISUALLY INSPECT WITH PARTICULAR ATTENTION TO KINKS, BENDS AND BREAKS. IF AN ABNORMALITY IS DETECTED THAT WOULD PROHIBIT PROPER WORKING CONDITION, DO NOT USE". THERE IS NO EVIDENCE TO SUGGEST THAT THE CUSTOMER DID NOT FOLLOW THE INSTRUCTIONS FOR USE. A DEFINITIVE ROOT CAUSE FOR THE CUSTOMER COMPLAINT COULD NOT BE DETERMINED AS CIRCUMSTANCES OF USE CANNOT BE REPLICATED IN THE LABORATORY. A POSSIBLE CAUSE COULD BE ATTRIBUTED TO ADVANCEMENT INTO A HARD LESION. COMPLAINT IS CONFIRMED BASED ON THE CUSTOMER'S TESTIMONY. ACCORDING TO THE INITIAL REPORTER, THE PATIENT DID NOT EXPERIENCE ANY ADVERSE EFFECTS DUE TO THIS OCCURRENCE. COMPLAINTS OF THIS NATURE WILL CONTINUE TO BE MONITORED FOR POTENTIAL EMERGING TRENDS.

Description of Event or Problem · 0

AS REPORTED TO CUSTOMER RELATIONS (CR), "THE DOCTOR REPORTS DIFFICULTY IN MANEUVERING THE HANDLE AND WHEN PUNCTURING AND RETRACTING THE NEEDLE IT GOT STUCK, IN BOTH NEEDLES THE SAME HAPPENS. NO PATIENT COMPLICATION. THE DOCTOR DECIDED TO USE ANOTHER NEEDLE OF THE BOSTON BRAND. BOTH NEEDLES WERE USED ONLY AND THEY DID NOT ACHIEVE TISSUE SINCE THEY WERE TUBED. THE NEEDLE IS REVISED AND WE OBSERVE THAT THE NEEDLE OF BOTH DEVICES HAS A BURR.

Description of Event or Problem · 0

AS REPORTED TO CUSTOMER RELATIONS (CR), THE DOCTOR REPORTED DIFFICULTY IN MANOUVERING THE HANDLE AND WHEN PUNCTURING AND RETRACTING THE NEEDLE IT GETS STUCK, IN BOTH NEEDLES THE SAME HAPPENS. NO PATIENT COMPLICATION. THE DOCTOR DECIDED TO USE ANOTHER NEEDLE OF THE BOSTON BRAND. BOTH NEEDLES WERE USED ONLY AND THEY DID NOT ACHIEVE TISSUE SINCE THEY WERE TUBBED. THE NEEDLE IS REVISED AND WE OBSERVE THAT THE NEEDLE OF BOTH DEVICES HAS A BURR.

Description of Event or Problem · 0

AS REPORTED TO CUSTOMER RELATIONS (CR), THE DOCTOR REPORTED DIFFICULTY IN MANOEUVERING THE HANDLE AND WHEN PUNCTURING AND RETRACTING THE NEEDLE IT GETS STUCK, IN BOTH NEEDLES THE SAME HAPPENS. NO PATIENT COMPLICATION. THE DOCTOR DECIDED TO USE ANOTHER NEEDLE OF THE BOSTON BRAND. BOTH NEEDLES WERE USED ONLY AND THEY DID NOT ACHIEVE TISSUE SINCE THEY WERE TUBED. THE NEEDLE IS REVISED AND WE OBSERVE THAT THE NEEDLE OF BOTH DEVICES HAS A BURR.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
860771 ECHOTIP PROCORE HIGH DEFINITION ULTRASOUND BIOPSY NEEDLE FCG KIT, NEEDLE, BIOPSY FCG COOK IRELAND LTD G53585 C1427326 00827002535855

Patients

Seq Age Sex Outcome Treatment
1 58 YR Required Intervention