MAUDE Adverse Event Report: ABBOTT VASCULAR HI-TORQUE BALANCE MIDDLEWEIGHT ELITE GUIDE WIRE

Model Number	1011880
Medical Device Problem Code	Material Separation (1562)
Health Effect - Clinical Code	No Patient Involvement (2645)
Date of Event	10/14/2020
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
The device was not returned for evaluation.A review of the lot history record identified no manufacturing nonconformities issued to the reported lot that would have contributed to this event.Based on the similar incident review, there is no indication of a lot specific product quality issue.There was no damage noted to the guide wire during the inspection prior to use to suggests a product quality issue.The investigation determined the reported core separation appear to be related to operational circumstances of the procedure.Base on the reported information, it is likely that manipulation, and/or inadvertent mishandling during the tip shape process.The guide wire likely kinked and separated.There is no indication of a product quality issue with respect to the design, manufacture, or labeling of the device.
Event or Problem Description
It was reported that during device preparation, the balance middle weight (bmw) guidewire proximal/medial section separated while curving the tip.There was no unusual resistance, or issue handling the device.Insertion was not attempted, and the device was set aside.There was no patient involvement.No additional information was provided regarding this device issue.
Additional Manufacturer Narrative
A visual inspection was performed on the returned guide wire and the reported separation was confirmed.A review of the lot history record identified no manufacturing nonconformities issued to the reported lot that would have contributed to this event.Based on the similar incident review, there is no indication of a lot specific product quality issue.There was no damage noted to the guide wire during the inspection prior to use which suggests a product quality issue with respect to manufacture, design or labeling did not contribute to the reported difficulties.The investigation determined the reported core separation appear to be related to operational circumstances of the procedure.Base on the reported information, it is likely that manipulation and/or inadvertent mishandling during the tip shape process, the guide wire core likely kinked at the proximal end of the hypotube and separated.There was still core visible inside the hypotube.The fractured faces at the separation were bent as if kinked prior to separation.The coil damage likely occurred during tip shape.The noted teflon coating damage likely occurred during retraction through the torque device used in the procedure.The noted kinks on the core likely occurred during packing for return analysis.There is no indication of a product quality issue with respect to the design, manufacture, or labeling of the device.D9, h3: it was initially reported that the device was discarded.Subsequently, the device was returned for evaluation.H6: method code 4115 removed.

• Brand Name: HI-TORQUE BALANCE MIDDLEWEIGHT ELITE GUIDE WIRE
• Common Device Name: GUIDE WIRE
• Manufacturer (Section D): ABBOTT VASCULAR; 26531 ynez rd.; temecula CA 92591 4628
• MDR Report Key: 10779606
• Report Number: 2024168-2020-09181
• Device Sequence Number: 3246631
• Product Code: DQX
• UDI-Device Identifier: 08717648144783
• UDI-Public: 08717648144783
• Combination Product (Y/N): N
• Initial Reporter State: LA
• Initial Reporter Country: US
• PMA/510(K) Number: K103101
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): N
• Reporter Type: Manufacturer
• Report Source: company representative,health
• Initial Reporter Occupation: Physician
• Type of Report: Initial,Followup
• Report Date (Section B): 02/10/2021

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
• Operator of Device: Health Professional
• Device Expiration Date: 02/28/2022
• Device Model Number: 1011880
• Device Catalogue Number: 1011880
• Device Lot Number: 0033061
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 12/30/2020
• Initial Date Received by Manufacturer: 10/14/2020
• Supplement Date Received by Manufacturer: 01/25/2021
• Initial Report FDA Received Date: 11/03/2020
• Supplement Report FDA Received Date: 02/10/2021
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1