FDA Adverse Event Injury Summary report: N

ZENITH ALPHA THORACIC ENDOVASCULAR GRAFT PROXIMAL COMPONENTS

MDR report key: 9937424 · Received April 8, 2020

Report

Report Number
3005580113-2020-00350
Event Type
Injury
Date Received
April 8, 2020
Date of Event
March 17, 2020
Report Date
April 8, 2020
Manufacturer
WILLIAM COOK EUROPE
Product Code
MIH
UDI-DI
10827002353678
Adverse Event
Yes
Product Problem
Yes
Report Source
Distributor report
Reporter Location
AR, US
Reporter Occupation
OTHER

Narratives

Description of Event or Problem · 1

DESCRIPTION OF EVENT ACCORDING TO INITIAL REPORTER: A (B)(6) YEAR OLD MALE PATIENT UNDERWENT A TVAR PROCEDURE IN WHICH THE ZENITH ALPHA THORACIC ENDOVASCULAR GRAFT PROXIMAL COMPONENTS, G35367, WAS USED. THE LAST GRAFT PIECE, G35367, WAS USED FOR BRIDGING BETWEEN TWO GRAFTS AS THE PROXIMAL GRAFT WAS TOO SHORT WITH THE DISTAL PIECE. WHEN THE PHYSICIAN FINISHED AND ROTATED THE DELIVERY SYSTEM THE NOSE CONE OF THE DEVICE INNER WHITE CANNULA CAME OFF AND STAYED ON THE WIRE END OF THE GRAFT. LEAVING THE NOSE CONE AND INNER CANNULA IN THE PATIENT. THE PHYSICIAN THEN ADVANCED A LONGER AND LARGER SHEATH AND SNARED THE SHEATH TO REMOVE FROM THE PATIENT. ADDITIONAL INFORMATION RECEIVED 20MAR2020: AFTER RELEASING THE STENT GRAFT, THE PHYSICIAN RETRIEVED THE INNER SYSTEM AND LEFT THE OUTER SHEATH IN ORDER TO PERFORM BALLOONING. WHEN THE INNER SYSTEM WAS TAKEN OUT, IT WAS NOTED THAT THE SYSTEM ONLY CONTAINED THE GREY POSITIONER ALONG WITH THE HANDLE AND THE TIP ASSEMBLY (DILATOR TIP AND CANNULA) WAS LEFT IN PATIENT. THERE WAS VERY TORTUROUS ANATOMY AND WE WERE WELL IN THE ARCH AROUND ZONE 2. SOME DIFFICULTY RETRIEVING DEVICE OVER THE ARCH BUT AS EXPECTED WITH THE ANATOMY AND SIZE OF ANEURYSM. PATIENT OUTCOME: 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
402038 ZENITH ALPHA THORACIC ENDOVASCULAR GRAFT PROXIMAL COMPONENTS MIH SYSTEM, ENDOVASCULAR GRAFT, AORTIC ANEURYSM TREATMENT MIH WILLIAM COOK EUROPE G35367 E3938709 10827002353678

Patients

Seq Age Sex Outcome Treatment
1 66 YR Required Intervention