MAUDE Adverse Event Report: WILLIAM A. COOK AUSTRALIA, PTY LTD ZENITH FENESTRATED AAA ENDOVASCULAR GRAFT DISTAL BIFURCATED BODY; MIH SYSTEM, ENDOVASCULAR GRAFT, AORTIC ANEURYSM TREATMENT

Model Number	G32551
Medical Device Problem Code	Material Separation (1562)
Health Effect - Clinical Code	No Code Available (3191)
Date of Event	05/20/2020
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
(b)(4).
Event or Problem Description
According to the initial reporter, the proximal graft and the distal graft separated creating a type 3 endoleak.It was reported that the patient underwent intervention on (b)(6) 2020.It was further reported: yes surgical intervention was required.The distal fenestrated component lost its overlap with the proximal fenestrated component.The distal component migrated down into the aneurysm at a difficult angle posteriorly.Also, the right and left iliac limbs lost seal within the common iliacs and migrated up into the aneurysm.The distal fenestrated graft and limbs folded in the aneurysm making reintervention difficult.Physician accessed the axillary artery and put a 8fr sheath down into the aorta.He stented the sma with a gore 8x29 vbx and stented the left renal artery with a gore 6x29 vbx.He then drove a wire down into the proximal fenenstrated graft.He was able to snake the wire into the distal graft and through the left iliac limb.The physician accessed both femoral arteries and then from the left side snared the wire from above.Once he had wire access he exchanged it to a stiff wire which helped straighten out the folded graft.He then accessed the patients right femoral artery with a wire and was able to get access into the aorta from both sides.He decided to reline the graft with a gore excluder graft.All grafts remained inside the body.Physician was able to gain access to the device and reline our device with gore grafts.After the relining the grafts with the gore endografts an angiogram confirmed that the aneurysm was now sealed with no endoleak.

• Brand Name: ZENITH FENESTRATED AAA ENDOVASCULAR GRAFT DISTAL BIFURCATED BODY
• Common Device Name: MIH SYSTEM, ENDOVASCULAR GRAFT, AORTIC ANEURYSM TREATMENT
• Manufacturer (Section D): WILLIAM A. COOK AUSTRALIA, PTY LTD; 95 brandl street; eight mile plains; brisbane QLD 4 113; AS QLD 4113
• MDR Report Key: 10119713
• Report Number: 3005580113-2020-00372
• Device Sequence Number: 14319668
• Product Code: MIH
• UDI-Device Identifier: 10827002325514
• UDI-Public: (01)10827002325514(17)201103(10)AC1006353
• Combination Product (Y/N): N
• Initial Reporter State: IN
• Initial Reporter Country: US
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2017
• Reporter Type: Importer
• Initial Reporter Occupation: Physician
• Type of Report: Initial
• Report Date (Section B): 06/04/2020
• Report Date (Section F): 06/04/2020

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
• Operator of Device: Health Professional
• Device Expiration Date: 11/03/2020
• Device Model Number: G32551
• Device Catalogue Number: ZFEN-D-12-28-76-C
• Device Lot Number: AC1006353
• Was Device Available for Evaluation?: No
• Was the Report Sent to FDA?: Yes
• Distributor Facility Aware Date: 06/20/2020
• Event Location: Hospital
• Date Report to Manufacturer: 06/04/2020
• Initial Date Received by Manufacturer: Not provided
• Initial Report FDA Received Date: 06/04/2020
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1
• Outcome Attributed to Adverse Event: Required Intervention
• Patient Age: 64 YR