MAUDE Adverse Event Report: APOLLO ENDOSURGERY BIB SYSTEM INTRAGASTRIC BALLOON

Model Number B-40800

Device Problems Fluid/Blood Leak (1250); Migration or Expulsion of Device (1395)

Patient Problems Abdominal Pain (1685); Failure of Implant (1924); Nausea (1970); Vomiting (2144)

Event Date 10/25/2020

Event Type  malfunction  

Manufacturer Narrative

Initial medwatch submitted to the fda on 01/dec/2020.The device was returned to the apollo device analysis laboratory on 16/nov/2020.Analysis of the device is ongoing.A review of the device labeling notes the following: the current bib¿ system intragastric balloon directions for use (dfu) addresses the known and anticipated potential events of "nausea", "vomiting", "pain" as follows: precautions: antiemetics, antispasmodic, and anticholinergic drugs may be prescribed to lessen the early placement symptoms such as nausea, vomiting, and abdominal pain.Patients will need to immediately contact their physician for any severe or unusual symptoms.Placement of the balloon within the stomach produces an expected, and predictable reaction characterized most commonly by a feeling of heaviness in the abdomen, nausea and vomiting, gastroesophageal reflux, belching, esophagitis, heartburn, diarrhea and, at times, abdominal, back or epigastric pain and cramping.Food digestion may be slowed during this adjustment period.These symptoms can be treated with antiemetic, antispasmodic, and anticholinergic medications.Typically the stomach acclimates to the presence of the device within the first 2 weeks.In order to prevent, or ameliorate the symptoms most frequently experienced during the adjustment period, it is recommended that the physician use proton pump inhibitors (ppis), antiemetics, antispasmodics, and anticholinergic medications prophylactically (before bib¿ placement).Patients should be advised to immediately contact their physician for any unusually severe, or worsening symptoms.The physiological response of the patient to the presence of bib¿ may vary depending upon the patient's general condition, and the level and type of activity.The types and frequency of administration of drugs or diet supplements, and the overall diet of the patient may also affect the response.Each patient must be monitored closely during the entire term of treatment in order to detect the development of possible complications.Each patient should be instructed regarding symptoms of deflation, gastrointestinal obstruction, ulceration, and other complications, which might occur, and should be advised to contact his/her physician immediately upon the onset of such symptoms.Patients need to be evaluated and the device removed at or within 6 months of placement.Clinical data does not exist to support use of an individual bib¿ beyond 6 months.Adverse events: it is important to discuss all possible complications and adverse events with your patient.Complications that may result from the use of this product include the risks associated with the medications, and methods utilized in the endoscopic procedure, the risks associated with any endoscopic procedure, the risks associated with the bib¿ intragastric balloon specifically, and the risks associated with the patient's degree of intolerance to a foreign object placed in the stomach.Possible complications of the use of bib¿ include: gastric discomfort, feelings of nausea and vomiting, following balloon placement as the digestive system adjusts to the presence of the balloon.Continuing nausea and vomiting.This could result from direct irritation of the lining of the stomach, delayed gastric emptying and/or the balloon blocking the outlet of the stomach.It is even theoretically possible that the balloon could prevent vomiting (not nausea or retching) by blocking the inlet to the stomach from the esophagus.Abdominal or back pain; either steady, or cyclic.

Event Description

The patient presented with nausea, vomiting, and pain.The balloon deflated, and cleared the patient's body.

Manufacturer Narrative

Supplement #1 medwatch submitted to the fda on 14/jan/2021.Additional information: h3, h6, and h10 device evaluation summary: the device was returned to the apollo device analysis laboratory on 16/nov/2020.Deflated balloon with a significant amount of discoloration and a large hole on the shell.The large hole on the shell runs from the slit valve to the distal end and has smooth.Due to the large hole, functional evaluation of the device could not be conducted.The complaint has been verified as it is uncertain how the large hole was created as the tear has smooth edges which is not consistent with a puncture from a surgical instrument.

• Brand Name: BIB SYSTEM INTRAGASTRIC BALLOON
• Type of Device: INTRAGASTRIC BALLOON
• Manufacturer (Section D): APOLLO ENDOSURGERY; 1120 s. capital of texas hwy; bldg 1, ste. 300; austin TX 78746
• MDR Report Key: 10928257
• MDR Text Key: 218963082
• Report Number: 3006722112-2020-00120
• Device Sequence Number: 1
• Product Code: LTI
• UDI-Device Identifier: 10811955020510
• UDI-Public: (01)10811955020510(17)2022-02-13(10)AF03588
• Combination Product (y/n): N
• PMA/PMN Number: P140008
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: company representative,foreig
• Type of Report: Initial,Followup
• Report Date: 01/08/2021

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: Yes
• Device Operator: Health Professional
• Device Expiration Date: 02/13/2022
• Device Model Number: B-40800
• Device Catalogue Number: B-40800
• Device Lot Number: AF03588
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 11/16/2020
• Initial Date Manufacturer Received: 11/04/2020
• Initial Date FDA Received: 12/01/2020
• Supplement Dates Manufacturer Received: 11/16/2020
• Supplement Dates FDA Received: 01/14/2021
• Is This a Reprocessed and Reused Single-Use Device?: No
• Patient Sequence Number: 1
• Patient Outcome(s): Required Intervention
• Patient Age: 29 YR