MAUDE Adverse Event Report: COOK IRELAND LTD ZILVER PTX 35 DRUG-ELUTING STENT; NIO STENT, ILIAC

Catalog Number ZIV6-35-125-6-100-PTX

Device Problems Obstruction of Flow (2423); Appropriate Term/Code Not Available (3191)

Patient Problem No Consequences Or Impact To Patient (2199)

Event Date 06/15/2018

Event Type  Injury  

Manufacturer Narrative

Pma/510(k) #: p100022/s001.(b)(4).Investigation is still pending.A follow up mdr will be submitted to include the investigation conclusions.Complaints of this nature will continue to be monitored for potential emerging trends.

Event Description

(b)(6) pt.Experienced an occlusion/restenosis within the study lesion, probably r/t study product & procedure.One (b)(6) study stent was placed during the index procedure on (b)(6) 2015.On (b)(6) 2015, the patient received one (b)(6) study stent in the right proximal sfa via a contralateral access site.The study lesion was 20.0 mm in length with 70% diameter stenosis in study lesion.Pre-stent dilatation was not performed.Post-stent dilatation was performed.There was no thrombus or dissection post stenting, with no residual stenosis remaining.On (b)(6) 2018 (980 days post-procedure), the patient experienced worsened "an" occlusion/restenosis within the study lesion.Treatment included atherectomy and drug coated balloon angioplasty on (b)(6) 2018 (994 days post-procedure) [note: the site has not submitted the secondary intervention form yet; no further information is available].The event was considered probably related to the study product and the study procedure [the site has been queried regarding rationale for probably related to study procedure].Pre-existing peripheral arterial disease was also noted to have caused or contributed to the event.The site marked no to the question: did the device malfunction or deteriorate in characteristics or performance?.

Event Description

12-004, pt.Experienced an occlusion/restenosis within the study lesion, probably r/t study product & procedure.One zilver® ptx® v study stent was placed during the index procedure on (b)(6) 2015.On (b)(6) 2015, the patient received one zilver ptx study stent in the right proximal sfa via a contralateral access site.The study lesion was 20.0 mm in length with 70% diameter stenosis in study lesion.Pre-stent dilatation was not performed.Post-stent dilatation was performed.There was no thrombus or dissection post stenting, with no residual stenosis remaining.On (b)(6)2018 (980 days post-procedure), the patient experienced worsened an occlusion restenosis within the study lesion.Treatment included atherectomy and drug coated balloon angioplasty on (b)(6) 2018 (994 days post-procedure).[note, the site has not submitted the secondary intervention form yet, no further information is available.The event was considered probably related to the study product and the study procedure.[the site has been queried regarding rationale for probably related to study procedure.] pre-existing peripheral arterial disease was also noted to have caused or contributed to the event.The site marked no to the question: did the device malfunction or deteriorate in characteristics or performance?.

Manufacturer Narrative

Pma/510(k) # p100022/s001.Cook ireland ltd (manufacturer) is submitting this report on behalf of cook medical incorporated (cmi)(importer).Exemption number: (b)(4).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: (b)(4).Investigation is still pending.A follow up mdr will be submitted to include the investigation conclusions.Complaints of this nature will continue to be monitored for potential emerging trends.

Event Description

This report is being submitted as a cancellation report based on the receipt of information that the 2nd device this file was opened for was not present.Please refer to 3001845648-2018-00545 for details of the stent which was confirmed to be in place.12-004, pt.Experienced an occlusion/restenosis within the study lesion, probably r/t study product & procedure.One zilver® ptx® v study stent was placed during the index procedure on 09-oct-2015 on (b)(6) 2015, the patient received one zilver ptx study stent in the right proximal sfa via a contralateral access site.The study lesion was 20.0 mm in length with 70% diameter stenosis in study lesion.Pre-stent dilatation was not performed.Post-stent dilatation was performed.There was no thrombus or dissection post stenting, with no residual stenosis remaining.On (b)(6) 2018 (980 days post-procedure), the patient experienced worsened an occlusion/restenosis within the study lesion.Treatment included atherectomy and drug coated balloon angioplasty on (b)(6) 2018 (994 days post-procedure).[note, the site has not submitted the secondary intervention form yet, no further information is available.The event was considered probably related to the study product and the study procedure.[the site has been queried regarding rationale for probably related to study procedure.] pre-existing peripheral arterial disease was also noted to have caused or contributed to the event.The site marked no to the question: did the device malfunction or deteriorate in characteristics or performance?.

Manufacturer Narrative

Pma/510(k) #= p100022/s001.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.This report is being submitted as a cancellation report based on the receipt of information that the 2nd device this file was opened for was not present in the patient.Please refer to 3001845648-2018-00545 for details of the stent which was confirmed to be in place.

• Brand Name: ZILVER PTX 35 DRUG-ELUTING STENT
• Type of Device: NIO STENT, ILIAC
• Manufacturer (Section D): COOK IRELAND LTD; o halloran road; limerick
• MDR Report Key: 8100876
• MDR Text Key: 128257531
• Report Number: 3001845648-2018-00544
• Device Sequence Number: 1
• Product Code: NIO
• Combination Product (y/n): N
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: company representative,health
• Type of Report: Initial,Followup,Followup
• Report Date: 12/19/2018

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 11/26/2018
• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: No
• Device Operator: Health Professional
• Device Catalogue Number: ZIV6-35-125-6-100-PTX
• Was Device Available for Evaluation?: No
• Was the Report Sent to FDA?: No
• Distributor Facility Aware Date: 10/26/2018
• Event Location: Hospital
• Date Manufacturer Received: 10/30/2018
• Is This a Reprocessed and Reused Single-Use Device?: No
• Patient Sequence Number: 1
• Patient Outcome(s): Required Intervention
• Patient Age: 57 YR