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Model Number FEL10120 |
Device Problems
Positioning Failure (1158); Fracture (1260); Misfire (2532)
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Patient Problem
No Consequences Or Impact To Patient (2199)
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Event Date 07/28/2017 |
Event Type
malfunction
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Manufacturer Narrative
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No medical records or no medical images have been made available to the manufacturer.As the lot number for the device was provided, a review of the device history records is currently being performed.The device has been returned to the manufacturer for evaluation.The investigation of the reported event is currently underway.The information provided by bard represents all of the known information at this time.Despite good faith efforts to obtain additional information, the complainant / reporter was unable or unwilling to provide any further patient, product, or procedural details to bard.
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Event Description
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It was reported that during deployment the endovascular stent graft allegedly only partially deployed, as there was no more room to continue with the pin and pull action in order to fully deploy the stent graft.Therefore, the delivery system was removed with the partial deployed stent without incident.Reportedly, another device was used to complete the procedure.There was no reported patient injury.
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Manufacturer Narrative
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Manufacturing review: the lot history records have been reviewed with special attention to the manufacturing and inspection of this product and the product was found to have met the specification prior to shipment.The review showed that no remarkable incidents occurred during the manufacturing process.Investigation summary: on the basis of the returned stent graft delivery system, the alleged partial deployment was confirmed as the stent graft was found completely loaded in the system.Additionally, the reported impossibility to deploy the stent graft was also confirmed.The outer sheath was found to be elongated which indicated that increased friction affected the delivery system during attempt of stent graft deployment and subsequently resulted in an outer sheath fracture.As a result of the investigation performed the complaint was confirmed.However, based on the available information and the evaluation of the returned sample, a definite root cause for the reported event could not be determined.Labeling review: in reviewing the labeling supplied with this product it was found that the instructions for use (ifu) sufficiently address the potential risk.The ifu states: "if unusual resistance or high deployment force is encountered during stent graft deployment, abort the procedure, remove the delivery system and use an alternative device." regarding the use of accessories the ifu states: "materials required for the fluency® plus endovascular stent graft procedure: (.) introducer sheath with appropriate inner diameter (.)" and "the use of an appropriately sized introducer sheath is recommended." furthermore, the ifu states: "do not kink the delivery catheter or use excessive force during delivery to the target lesion." and "prior to loading the endovascular system over a guide wire, both ports must be flushed with sterile saline (¿).Flushing these lumens will also facilitate stent graft deployment.".
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Event Description
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It was reported that during deployment the endovascular stent graft allegedly only partially deployed, as there was no more room to continue with the pin & pull action in order to fully deploy the stent graft.Therefore, the delivery system was removed with the partial deployed stent without incident.Reportedly, another device was used to complete the procedure.There was no reported patient injury.
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Search Alerts/Recalls
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