MAUDE Adverse Event Report: BOSTON SCIENTIFIC CORPORATION FLEXIMA BILIARY; CATHETER, BILIARY, DIAGNOSTIC

Model Number	M00539210
Medical Device Problem Codes	Positioning Failure (1158); Retraction Problem (1536); Material Deformation (2976); Material Twisted/Bent (2981); Appropriate Device Problem Term/Code Not Available (3191)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	03/23/2021
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
(b)(6).(b)(4).The device has not been received for analysis.Upon receipt and completion of the failure analysis of the complaint device, if there is any further relevant information from that review, a supplemental medwatch will be filed.
Event or Problem Description
Note: this report is two of three complaints that pertain to the same event (mfr.# 3005099803-2021-01664 and mfr.Report # 3005099803-2021-01667).It was reported to boston scientific corporation that a flexima biliary stent was used during an endoscopic retrograde cholangiopancreatography in the biliary duct performed on (b)(6) 2021.During the procedure, three stents were deployed unsuccessfully.It was reported that they had difficulty retracting the pull wire to release the suture, and the suture was tangled.A photo of the device was provided and showed that the guide catheter kinked.The procedure was cancelled due to this event and rescheduled.There were no patient complications reported as a result of this event.
Additional Manufacturer Narrative
Block e1: initial reporter state: (b)(6) initial reporter phone: extension number (b)(6) block h6: device code a27 is being used to capture the reportable issue of aborted/cancelled procedure.Conclusion code d17 is being used in lieu of an adequate conclusion code for device not returned.Block h10: the device has not been received for analysis.Upon receipt and completion of the failure analysis of the complaint device, if there is any further relevant information from that review, a supplemental medwatch will be filed.Block h11: correction to block block b5 (describe event or problem) block h6: removed device code a0510 for pullwire retraction problem.
Event or Problem Description
Note: this report is two of three complaints that pertain to the same event (mfr report # 3005099803-2021-01662, mfr.# 3005099803-2021-01664 and mfr.Report # 3005099803-2021-01667).It was reported to boston scientific corporation that a flexima biliary stent was used during an endoscopic retrograde cholangiopancreatography in the biliary duct performed on (b)(6), 2021.During the procedure, three stents were deployed unsuccessfully.It was reported that they had difficulty releasing the suture, and the suture was tangled.A photo of the device was provided and showed that the guide catheter kinked.The procedure was cancelled due to this event and rescheduled.There were no patient complications reported as a result of this event.
Event or Problem Description
Note: this report is two of three complaints that pertain to the same event (mfr report # 3005099803-2021-01662, mfr.# 3005099803-2021-01664 and mfr.Report # 3005099803-2021-01667).It was reported to boston scientific corporation that a flexima biliary stent was used during an endoscopic retrograde cholangiopancreatography in the biliary duct performed on(b)(6), 2021.During the procedure, three stents were deployed unsuccessfully.It was reported that they had difficulty releasing the suture, and the suture was tangled.A photo of the device was provided and showed that the guide catheter kinked.The procedure was cancelled due to this event and rescheduled.There were no patient complications reported as a result of this event.
Additional Manufacturer Narrative
Block e1: initial reporter state: 11 initial reporter phone: extension number(b)(6) block h6: device code a27 is being used to capture the reportable issue of aborted/cancelled procedure.Conclusion code d17 is being used in lieu of an adequate conclusion code for device not returned.Block h10: the returned flexima biliary stent was analyzed, and a visual evaluation noted that the stent was attached to the push catheter by the suture.The guide catheter was kinked close to the proximal section.A photo of the complaint device was provided and showed that the guide catheter was kinked as a consequence for the stent failure to deploy.The suture was observed correctly attached and in good condition.No other problems with the device were noted.The reported complaints of stent failure to deploy and guide catheter kinked were confirmed.Upon analysis, it was revealed that the suture was observed correctly attached and it did not show visual problems.The reported complaint of "suture twisted" was not confirmed and the most probable root cause for this event is 'no problem detected'.The push catheter was kinked, this may be related to user manipulation, some technique applied during procedure and/or anatomical factors, once the push catheter was kinked this could have created some resistance while pulling the guide catheter out to deploy the stent, as consequence of this the guide catheter could have ended kinked.Therefore, this avoided the deployment of the stent and the attempts of deploying the stent may have caused the torn on the suture hole.The reported complaints of "stent failure to deploy and guide catheter kinked" are confirmed and the observed problems of "push catheter kinked and push catheter suture hole torn" will be documented as a not reported allegations, and the root cause of the problems found is adverse event related to procedure since the adverse event occurred during the procedure and the device had no influence on event.A review of the manufacturing documentation for this device revealed that no anomalies or deviations related to the event occurred during manufacturing.

• Brand Name: FLEXIMA BILIARY
• Common Device Name: CATHETER, BILIARY, DIAGNOSTIC
• Manufacturer (Section D): BOSTON SCIENTIFIC CORPORATION; 300 boston scientific way; marlborough MA 01752
• MDR Report Key: 11686952
• Report Number: 3005099803-2021-01662
• Device Sequence Number: 11545376
• Product Code: FGE
• UDI-Device Identifier: 08714729162520
• UDI-Public: 08714729162520
• Combination Product (Y/N): N
• Initial Reporter Country: CO
• PMA/510(K) Number: K965147
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): Unknown
• Reporter Type: Manufacturer
• Report Source: company representative,foreig
• Initial Reporter Occupation: Other Health Care Professional
• Type of Report: Initial,Followup,Followup
• Report Date (Section B): 08/24/2021

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: 07/07/2023
• Device Model Number: M00539210
• Device Catalogue Number: 3921
• Device Lot Number: 0025680706
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 07/12/2021
• Initial Date Received by Manufacturer: 03/23/2021
• Supplement Date Received by Manufacturer: 04/20/2021; 07/27/2021
• Initial Report FDA Received Date: 04/19/2021
• Supplement Report FDA Received Date: 05/17/2021; 08/24/2021
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1