MAUDE Adverse Event Report: MEDTRONIC CRYOCATH LP FLEXCATH ADVANCE STEERABLE SHEATH; CATHETER, STEERABLE

Model Number 4FC12

Device Problem Adverse Event Without Identified Device or Use Problem (2993)

Patient Problems Bradycardia (1751); Cardiac Arrest (1762); Death (1802); Non specific EKG/ECG Changes (1817); Low Blood Pressure/ Hypotension (1914); ST Segment Elevation (2059)

Event Date 10/15/2020

Event Type  Death  

Manufacturer Narrative

If information is provided in the future, a supplemental report will be issued.

Event Description

It was reported that during a cryoablation procedure, after inserting the sheath, the patient displayed st elevation.The patient then became bradycardic and hypotensive.The case was aborted.Resuscitation efforts were performed with no avail.The patient is deceased.

Event Description

It was reported that during a cryo ablation procedure, after inserting the sheath, the patient displayed st elevation on the electrocardiogram (ecg).The patient then became bradycardic and hypotensive.The angiogram showed an occluded left anterior descending artery, a partly occluded circumflex artery and the right coronary artery was unable to be visualized.The case was aborted.A percutaneous coronary intervention was performed and the arteries were able to be reopened.During the angiogram, the patient did not have a blood pressure and an asystole rhythm was detected on the ecg.Resuscitation efforts were performed.The patient is deceased.

Manufacturer Narrative

Correction: b5 product event summary: the 4fc12 sheath with lot number 0010358066 was returned and analyzed.Visual inspection showed the device was intact with no apparent issues.The deflection worked as per specification.The aspiration/flushing test did not show any air passing through the tube or expelled from the sheath distal tip.The hemostatic valve was leak tight.In conclusion, the clinical issues of st elevation, bradycardia, hypotension, cardiac arrest, and death occurred during the procedure and the decision to abort the procedure was based on the medical judgement of the physician.There is no indication of relation of adverse event to the performance and malfunction of the product.Medtronic is submitting this report to comply with fda reporting regulations under 21 cfr parts 4 and 803.This report is based upon information obtained by medtronic, which the company may not have been able to fully investigate or verify prior to the date the report was required by the fda.Medtronic has made reasonable efforts to obtain more complete information and has provided as much relevant information as is available to the company as of the submission date of this report.This report does not constitute an admission or a conclusion by fda, medtronic, or its employees that the device, medtronic, or its employee caused or contributed to the event described in the report.In particular, this report does not constitute an admission by anyone that the product described in this report has any ¿defects¿ or has ¿malfunctioned¿.These words are included in the fda 3500a form and are fixed items for selection created by the fda to categorize the type of event solely for the purpose of regulatory reporting.Medtronic objects to the use of these words and others like them because of the lack of definition and the connotations implied by these terms.This statement should be included with any information or report disclosed to the public under the freedom of information act.Any required fields that are unpopulated are blank because the information is currently unknown or unavailable.A good faith effort will be made to obtain the applicable information relevant to the report.If information is provided in the future, a supplemental report will be issued.

• Brand Name: FLEXCATH ADVANCE STEERABLE SHEATH
• Type of Device: CATHETER, STEERABLE
• Manufacturer (Section D): MEDTRONIC CRYOCATH LP; 9000 autoroute transcanadienne; pointe-claire,qc H9R 5 Z8; CA H9R 5Z8
• MDR Report Key: 10690656
• MDR Text Key: 211685146
• Report Number: 3002648230-2020-00548
• Device Sequence Number: 1
• Product Code: DRA
• Combination Product (y/n): N
• PMA/PMN Number: K123591
• 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: 12/11/2020

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 10/16/2020
• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: No
• Device Operator: Health Professional
• Device Expiration Date: 09/02/2022
• Device Model Number: 4FC12
• Device Catalogue Number: 4FC12
• Device Lot Number: 0010358066
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 10/26/2020
• Date Manufacturer Received: 11/20/2020
• Is This a Reprocessed and Reused Single-Use Device?: No
• Patient Sequence Number: 1
• Patient Outcome(s): Death