MAUDE Adverse Event Report: APOLLO ENDOSURGERY, INC. ORBERA INTRAGASTRIC BALLOON

Model Number B-4800

Device Problems Separation Problem (4043); Premature Separation (4045)

Patient Problem Failure of Implant (1924)

Event Date 06/15/2023

Event Type  malfunction  

Event Description

Healthcare professional reported the balloon separated from the catheter when passing through the esophagus.Case was aborted and completed the following day.Patient is doing well.

Manufacturer Narrative

Combined medwatch submitted to the fda on 19/jul/2023.A review of the device labeling notes the following: the current orbera¿ intragastric balloon system directions for use (dfu) addresses the known and anticipated potential events of difficulty with fill tube are as follows: warnings and precautions: proper positioning of the placement catheter assembly and the bib¿ system balloon within the stomach is necessary to allow proper inflation.Lodging of the balloon in the esophageal opening during inflation may cause injury and/or device rupture.The orbera¿ intragastric balloon system is composed of soft silicone elastomer and is easily damaged by instruments or sharp objects.The balloon must be handled only with gloved hands and with the instruments recommended in this document.Note: if the balloon becomes separated from the sheath prior to placement, do not attempt to use the balloon or reinsert the balloon into the sheath.Note: during the filling process the fill tube must remain slack.If the fill tube is under tension during the intubation process, the fill tube may dislodge from the balloon, preventing further balloon deployment.Warning: patients must be advised that the igb is intended to be placed for 6 months maximally, at which point removal is required.Longer periods of igb placement increase the risk of igb deflation (a reduction in size of the device due to loss of saline) which can lead to intestinal obstruction and risk for death.The risk of these events is also significantly higher when igbs are filled to a larger volume than indicated (greater than 700cc).Warning: when filling the igb during the placement procedure, avoid rapid fill rates as these will generate high pressure which can damage the igb valve or cause premature detachment of the igb from the tip of the placement catheter.The labeling is adequate as it addresses the reported complaint.Additional information: the investigator determined that a device history record (dhr) review is required for this complaint due to the complaint being mdr reportable.The subject product met all specifications and requirements in effect at the time of manufacture.There are no other complaints against this lot number, af05291, and allegation.Device evaluation summary: the device was returned to the apollo device analysis laboratory on 07/july/2023.A non-inflated balloon was returned with the fill tube tip disconnected from the slit valve.The fill tip was reinserted into the slit valve and the end of the balloon was clamped onto the pull force equipment, and it met minimum requirements.An attempt was made to inflate the balloon; however, the balloon did not inflate, and the fill tip disconnected from the slit valve.The fill tip was measured using a pin gauge and it met specifications.The complaint has been verified as the pressure to inflate the balloon exceeded requirements.: lab analysis was able to replicate the reported event of "difficulty with fill tube", as the fill pressure exceeded minimum requirements.The user effects of "difficulty with fill tube" is known and labeled possible adverse event.

• Brand Name: ORBERA INTRAGASTRIC BALLOON
• Type of Device: INTRAGASTRIC BALLOON
• Manufacturer (Section D): APOLLO ENDOSURGERY, INC.; 1120 s. capital of texas hwy; bldg. 1 ste. 300; austin TX 78746
• Manufacturer (Section G): APOLLO ENDOSURGERY COSTA RICA, SRL; coyol free zone; bldg b 13.3; alajuela, cs CRI ; CS CRI
• Manufacturer Contact: adriana russell ; 1120 s. capital of texas hwy; bldg. 1 ste. 300; austin, TX 78746 ; 5122795114
• MDR Report Key: 17350818
• MDR Text Key: 319396073
• Report Number: 3006722112-2023-00140
• Device Sequence Number: 1
• Product Code: LTI
• UDI-Device Identifier: 10811955020619
• UDI-Public: (01)10811955020619(17)20241025(10)AF05291
• Combination Product (y/n): N
• Reporter Country Code: US
• PMA/PMN Number: P140008
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Health Professional,Company Representative
• Reporter Occupation: Physician
• Type of Report: Initial
• Report Date: 06/23/2023

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Device Operator: Health Professional
• Device Model Number: B-4800
• Device Catalogue Number: B-4800
• Device Lot Number: AF05291
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 07/07/2023
• Is the Reporter a Health Professional?: Yes
• Initial Date Manufacturer Received: 06/23/2023
• Initial Date FDA Received: 07/19/2023
• Was Device Evaluated by Manufacturer?: Yes
• Date Device Manufactured: 10/25/2022
• 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 Age: 47 YR
• Patient Sex: Male
• Patient Weight: 137 KG