MAUDE Adverse Event Report: MEDTRONIC CRYOCATH LP CATHETER CONNECTING CABLE; CATHETER, ELECTRODE RECORDING, OR PROBE, ELECT

Model Number	2ACHC
Medical Device Problem Code	Device Contamination with Chemical or Other Material (2944)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	03/29/2021
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
If information is provided in the future, a supplemental report will be issued.
Event or Problem Description
It was reported that an undefined particle was observed in the packaging of the mapping catheter cable when removing it.The mapping catheter cable was replaced to resolve the issue.There was no patient involvement.
Additional Manufacturer Narrative
Product event summary: the 2achc mapping catheter cable with lot g20a08649 was returned and analyzed.The device was received in its original package (the package was opened) and a contaminant consisting of a piece of black small unknown material (around 0.25 inches ) was observed within the bag.Visual inspection of the cable showed the cable was intact with no apparent issues.There is no indication that the cable was used.In conclusion, the reported foreign material was confirmed through visual inspection.The mapping catheter failed inspection due to presence of a contaminant consisting of a piece of foreign material entrapped within the bag.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: CATHETER CONNECTING CABLE
• Common Device Name: CATHETER, ELECTRODE RECORDING, OR PROBE, ELECT
• Manufacturer (Section D): MEDTRONIC CRYOCATH LP; 9000 autoroute transcanadienne; pointe-claire,qc H9R 5 Z8; CA H9R 5Z8
• MDR Report Key: 11595067
• Report Number: 3002648230-2021-00147
• Device Sequence Number: 14509307
• Product Code: DRF
• UDI-Device Identifier: 00763000280024
• UDI-Public: 00763000280024
• Combination Product (Y/N): N
• Initial Reporter Country: SZ
• PMA/510(K) Number: K153139
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: company representative,foreig
• Initial Reporter Occupation: Physician
• Type of Report: Initial,Followup
• Report Date (Section B): 06/28/2021

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: 08/31/2022
• Device Model Number: 2ACHC
• Device Catalogue Number: 2ACHC
• Device Lot Number: G20A08649
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 05/28/2021
• Initial Date Received by Manufacturer: 03/29/2021
• Supplement Date Received by Manufacturer: 06/22/2021
• Initial Report FDA Received Date: 03/31/2021
• Supplement Report FDA Received Date: 06/28/2021
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1