MAUDE Adverse Event Report: BARD PERIPHERAL VASCULAR, INC. DORADO PTA DILATATION CATHETER; PTA BALLOON DILATATION CATHETER

Model Number	DR80510
Medical Device Problem Codes	Break (1069); Inflation Problem (1310); Leak/Splash (1354)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	03/08/2021
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
Manufacturing review: a manufacturing review was not required as this is the only complaint reported to date for this product and lot.Investigation summary: one dorado pta dilatation catheters was returned for evaluation.A visual inspection was performed and device appeared to be bloody.No other anomalies were noted to the device.An in house presto inflation device was used to inflate the device, and a leak was noted to the proximal end of the balloon.A circumferential glue joint break was noted to the proximal end of the balloon under magnification.No other functional test performed, due to condition of the device.Therefore, the investigation is confirmed for the identified glue joint break, as a glue joint break was noted during microscopic evaluation.The investigation is also confirmed for the identified leak issue, as water was noted to be leaking from the proximal balloon joint during functional testing.The investigation is confirmed for the reported inflation issue, as a leak was noted to the device during evaluation which contributed to the inflation issue.The glue joint break noted is the likely cause of the leak.However, the definitive root cause for the reported inflation issue, identified glue joint break and leak could not be determined based upon available information.Labeling review: the review of the instructions for use, indications, warnings, precautions, cautions, possible complications, and contraindications showed that the product labeling is adequate.(expiry date: 11/2023).
Event or Problem Description
It was reported that during an angioplasty procedure, the pta balloon allegedly failed to inflate on the first inflation attempt.It was further reported that leakage was found from the connection part of the balloon and the shaft.There was no reported patient injury.

• Brand Name: DORADO PTA DILATATION CATHETER
• Common Device Name: PTA BALLOON DILATATION CATHETER
• Manufacturer (Section D): BARD PERIPHERAL VASCULAR, INC.; 1625 w 3rd st.; tempe AZ 85281
• MDR Report Key: 11854654
• Report Number: 2020394-2021-01074
• Device Sequence Number: 11813052
• Product Code: LIT
• UDI-Device Identifier: 00801741058578
• UDI-Public: (01)00801741058578
• Combination Product (Y/N): N
• Initial Reporter Country: JA
• PMA/510(K) Number: K072283
• 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
• Report Date (Section B): 04/28/2021

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 Model Number: DR80510
• Device Catalogue Number: DR80510
• Device Lot Number: 93YE0081
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 03/23/2021
• Type of Report(Section G): Initial
• Initial Date Received by Manufacturer: 04/27/2021
• Initial Report FDA Received Date: 05/20/2021
• 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: Other