MAUDE Adverse Event Report: PEROUSE MEDICAL POLYSITE; POLYSITE IMPLANTABLE PORTS

Model Number 3017SPI

Device Problems Expulsion (2933); Separation Problem (4043)

Patient Problem Insufficient Information (4580)

Event Date 12/01/2023

Event Type  malfunction  

Event Description

Port insertion site opened up.Required port removal.

Manufacturer Narrative

Although the malfunctioning device was not returned to vygon, the details of the malfunction will be evaluated as part of the complaint investigation.The results of the investigation are still pending and will be communicated to the fda within thirty days of its conclusion via follow-up mdr.

Manufacturer Narrative

We contacted the customer and asked for more details about the incident.The customer has informed us that there is no defective product to return, and no further details can be provided about the insertion site or the device problem and why the port had to be removed, other than as stated in the incident description.As a result, this complaint could not be confirmed, and the root cause of the issue cannot be established.The most likely hypothesis that could explain the externalization phenomenon from the implantable port could be: · the use of an implantable port not adapted to the patient's morphology (dimension (too large), material, indication.An implantable port located less than 1 cm from the skin.Weight loss of the patient, the weakening of the patient's skin by chemo products.Unfortunately, without additional information and regarding our investigation, it is not possible to confirm these hypotheses.The review of the manufacturing batch record of the polysite 3017spi implantable port final product (lot 22090085) did not highlight any deviation that could be the root cause of the incident.Perouse medical has been made aware of two similar incidents involving this lot 22090085, both reported from the same hospital center.Perouse medical has not recorded similar incidents of port externalization between 2020 and 2023 across all its implantable catheter ports.On the other hand, we have been informed of four similar incidents in 2024 occurring in the same hospital.Corrective action: due to the missing sample and further information this complaint could not be confirmed, and the root cause of this issue cannot be established.Therefore, no further corrective action was initiated by quality management.

Event Description

Port insertion site opened up.Required port removal.

• Brand Name: POLYSITE
• Type of Device: POLYSITE IMPLANTABLE PORTS
• Manufacturer (Section D): PEROUSE MEDICAL; route du manoir; ivry, le temple 60173 ; FR 60173
• Manufacturer (Section G): PEROUSE MEDICAL; route du manoir; ivry, le temple 60173 ; FR 60173
• Manufacturer Contact: freda lacroix ; 2750 morris road; lansdale, PA 19446 ; 8004735414
• MDR Report Key: 18650587
• MDR Text Key: 334661236
• Report Number: 2245270-2024-00014
• Device Sequence Number: 1
• Product Code: LJT
• UDI-Device Identifier: 03661234017584
• UDI-Public: 03661234017584
• Combination Product (y/n): N
• Reporter Country Code: CA
• PMA/PMN Number: K122834
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Health Professional,User Facility
• Reporter Occupation: Other Health Care Professional
• Type of Report: Initial,Followup
• Report Date: 03/08/2024

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: 3017SPI
• Device Lot Number: 22090085
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Initial Date Manufacturer Received: 02/01/2024
• Initial Date FDA Received: 02/06/2024
• Supplement Dates Manufacturer Received: 02/01/2024
• Supplement Dates FDA Received: 03/08/2024
• Was Device Evaluated by Manufacturer?: No
• 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