MAUDE Adverse Event Report: BIOTRONIK AG, BUELACH, SWITZERLAND PASSEO-18 5/150/130; PERIPHERAL DILATATION CATHETER

Model Number 366134

Device Problems Fluid/Blood Leak (1250); Fracture (1260)

Patient Problem No Clinical Signs, Symptoms or Conditions (4582)

Event Date 02/07/2023

Event Type  Injury  

Event Description

The passeo-18 balloon catheter was chosen for treatment of a moderately calcified lesion (85 percent stenosis degree) in the moderately tortuous ostial segment of the left sfa.During pre-dilatation a leakage of the passeo-18 was detected.The balloon was removed, and the balloon was found fractured inside the body.The fractured parts in the vessel were finally removed by surgery, and the patient was stable.

Manufacturer Narrative

The returned instrument was subjected to a technical analysis and the corresponding product release documentation was reviewed to establish whether a deviation from the manufacturing process could be the cause for the reported event.The instrument was returned fractured in at least two parts.The distal fragment (distal end of the balloon, the tip, the inner shaft, and the distal x-ray marker) was not returned.At the proximal fragment the device inner shaft is plastically deformed, indicating application of a high tensile force.The balloon shows clear signs of inflation.The balloon has ruptured diagonally.In close vicinity of the tear scratches were observed which have likely been caused by a hard, sharp-edged object such as e.G., anatomical structure.The introducer sheath was not returned.Review of the lot release verification confirmed that the complaint instrument was manufactured according to specifications and successfully passed all in-process inspections as well as the final inspection.Based on the conducted investigations, no manufacturing or material related root cause could be determined.The balloon was most likely damaged by the patients anatomy, and the instrument then fractured as a result of tensile overload during withdrawal into the introducer sheath.It should be noted that the ifu instructs the user to pull out the dilatation catheter and the introducer sheath together in case of withdrawal difficulties.

• Brand Name: PASSEO-18 5/150/130
• Type of Device: PERIPHERAL DILATATION CATHETER
• Manufacturer (Section D): BIOTRONIK AG, BUELACH, SWITZERLAND; ackerstrasse 6; buelach CH-81 80; CH CH-8180
• Manufacturer Contact: 6024 jean road; lake oswego, OR 97035 ; 8772459800
• MDR Report Key: 16451914
• MDR Text Key: 310328950
• Report Number: 1028232-2023-01047
• Device Sequence Number: 1
• Product Code: LIT
• UDI-Device Identifier: 07640130414761
• UDI-Public: (01)07640130414761(17)2501
• Combination Product (y/n): N
• Reporter Country Code: CH
• PMA/PMN Number: K072765
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Other,Foreign,User Facility,Company Representative
• Reporter Occupation: Other Health Care Professional
• Type of Report: Initial,Followup
• Report Date: 05/10/2023

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 02/28/2023
• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: No
• Device Operator: Health Professional
• Device Model Number: 366134
• Device Catalogue Number: SEE MODEL NO.
• Device Lot Number: 01222721
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Is the Reporter a Health Professional?: Yes
• Date Manufacturer Received: 05/10/2023
• Was Device Evaluated by Manufacturer?: Yes
• Date Device Manufactured: 02/28/2022
• Is the Device Single Use?: Yes
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: Initial
• Patient Sequence Number: 1
• Patient Outcome(s): Required Intervention