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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: BARD PERIPHERAL VASCULAR, INC. CONQUEST 40; PTA BALLOON DILATATION CATHETER

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BARD PERIPHERAL VASCULAR, INC. CONQUEST 40; PTA BALLOON DILATATION CATHETER Back to Search Results
Catalog Number CQF7598
Device Problems Deflation Problem (1149); Inflation Problem (1310); Material Deformation (2976)
Patient Problem No Clinical Signs, Symptoms or Conditions (4582)
Event Date 05/19/2023
Event Type  malfunction  
Manufacturer Narrative
H10: manufacturing review: a manufacturing review was not required as this is the only complaint reported to date for this product and lot.Investigation summary: one conquest 40 pta dilatation catheter was received for evaluation with the balloon protector and stylet loaded onto the balloon at its distal end.During visual evaluation, stretching and bunching was observed on the catheter shaft.No anomalies were noted to the luers/bifurcate.During functional evaluation, the sample guidewire lumen was flushed.An in-house syringe was used to flush the in-house introducer sheath without any issues.The patency of the guidewire lumen was then tested using an in-house guidewire but was unsuccessful due to the condition of the device.The guidewire and sheath were removed.Then, an attempt to inflate the balloon was made and the balloon was able to be inflated after maneuvering the catheter.An attempt to deflate the balloon was unsuccessful.The balloon was cut and the glue bullet was noted to be seated correctly.No other functional testing was performed.Three photos were provided and reviewed.The first photo shows the conquest 40 balloon with the balloon protector over the distal part of the balloon.The balloon is seen deflated and bloody.The second photo shows the label of the device which matches with the information in trackwise.The third photo shows the luers of the device.No specific abnormalities can be seen.Therefore, the investigation is unconfirmed for the reported inflation issue as the balloon was able to be inflated.However, the investigation is confirmed for the identified material deformation as stretching and bunching was observed on the catheter shaft, and for the identified deflation issue as an attempt to deflate the balloon was unsuccessful.A definitive root cause for the reported inflation issue, identified material deformation and deflation issue could not be determined based upon the provided information.Labeling review: as the reported event did not allege a labeling or use related issue, a labeling review is not required.H10: d4 (expiry date: 06/2023) h11: section a through f ¿ the information provided by bd represents all 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 bd.H3 other text : see h10.
 
Event Description
It was reported that during an angioplasty procedure, the pta balloon allegedly failed to inflate.The procedure was completed using another device.There was no reported patient injury.
 
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Brand Name
CONQUEST 40
Type of Device
PTA BALLOON DILATATION CATHETER
Manufacturer (Section D)
BARD PERIPHERAL VASCULAR, INC.
1625 w 3rd st.
tempe AZ 85281
Manufacturer (Section G)
BARD REYNOSA S.A. DE C.V. -9617592
blvd. montebello #1
parque industrial colonial
reynosa, tamaulipas 88780
MX   88780
Manufacturer Contact
brett curtice
800 w. rio salado pkwy
tempe, AZ 85281
4803032689
MDR Report Key17948157
MDR Text Key325796154
Report Number2020394-2023-00877
Device Sequence Number1
Product Code DQY
UDI-Device Identifier00801741060618
UDI-Public(01)00801741060618
Combination Product (y/n)N
Reporter Country CodeUS
PMA/PMN Number
K120660
Number of Events Reported1
Summary Report (Y/N)N
Report Source Manufacturer
Source Type Other,Health Professional,User Facility,Company Representative
Reporter Occupation Physician
Type of Report Initial
Report Date 10/15/2023
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 Catalogue NumberCQF7598
Device Lot NumberREEU1564
Was Device Available for Evaluation? Device Returned to Manufacturer
Date Returned to Manufacturer06/23/2023
Is the Reporter a Health Professional? Yes
Initial Date Manufacturer Received 10/05/2023
Initial Date FDA Received10/17/2023
Was Device Evaluated by Manufacturer? Yes
Is the Device Single Use? Yes
Is This a Reprocessed and Reused Single-Use Device? No
Type of Device Usage Initial
Patient Sequence Number1
Patient Age79 YR
Patient SexMale
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