MAUDE Adverse Event Report: CORDIS CASHEL AVIATOR PLUS .014 5.0X20 142CM; CATHETER, ANGIOPLASTY, PERIPHERAL, TRANSLUMINAL

Model Number	4245020W
Medical Device Problem Code	Burst Container or Vessel (1074)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	08/24/2021
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
Additional information to include from facility name: (b)(6) hospital.Phone number: (b)(6).As reported, the.014 5.0x20 142cm aviator plus balloon catheter was used but it ruptured.There was no reported patient injury.The device was replaced with a new unknown device and the procedure was completed.The aviator was stored on the shelf.This was a renal artery stenosis (ras) case.There was no difficulty removing the product from the hoop, protective balloon cover, stylet, or any of the sterile packaging components.There were no damages noted to the balloon.There was no difficulty during preparation.The same indeflator device was used successfully with other devices.No other information was provided.The device was not returned for evaluation as it was discarded due by mistake.A product history record (phr) review of lot 82199400 revealed no anomalies or non-conformances during the manufacturing and inspection processes that can be associated with the reported event.The reported ¿balloon burst¿ could not be confirmed as the device was not returned for analysis.The exact cause could not be determined.Vessel characteristics and procedural factors, although unknown, may have contributed to the reported event.However, without the return of the device for analysis it is difficult to draw a clinical conclusion between the device and the event reported.According to the warnings in the safety information in the instructions for use ¿prior to use, the device should be examined to verify functionality and integrity, and ensure that its size is suitable for the specific procedure.Do not exceed the rated burst pressure recommended on the label.The rated burst pressure is based on the results of in-vitro testing.At least 99.9% of the balloons (with a 95% confidence) will not burst at or below their rated burst pressure.Use of a pressure-monitoring device is recommended to prevent over-pressurization.Use only the recommended balloon inflation medium (a 50/50 mixture by volume of contrast medium and normal saline).Never use air or any gaseous medium to inflate the balloon¿.Neither the phr nor the information available suggests a design or manufacturing related cause for the reported event; therefore, no corrective/preventive action will be taken at this time.
Event or Problem Description
As reported, the.014 5.0x20 142cm aviator plus balloon catheter was used but it ruptured.There was no reported patient injury.The device was replaced with a new unknown device and the procedure was completed.The aviator was stored on the shelf.This was a renal artery stenosis (ras) case.There were no difficulty removing the product from the hoop, protective balloon cover, stylet or any of the sterile packaging components.There were no damages noted to the balloon.There were no difficulty during preparation.The same indeflator device was used successfully with other devices.The device will not be returned for evaluation because it was discarded by mistake.No other information was provided.

• Brand Name: AVIATOR PLUS .014 5.0X20 142CM
• Common Device Name: CATHETER, ANGIOPLASTY, PERIPHERAL, TRANSLUMINAL
• Manufacturer (Section D): CORDIS CASHEL; cahir road; cashel, tipperary 0 ; EI 0
• MDR Report Key: 12476395
• Report Number: 9616099-2021-04870
• Device Sequence Number: 19806137
• Product Code: LIT
• UDI-Device Identifier: 20705032005828
• UDI-Public: 20705032005828
• Combination Product (Y/N): N
• Initial Reporter Country: JA
• PMA/510(K) Number: K071189
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: company representative,foreig
• Initial Reporter Occupation: Other
• Type of Report: Initial
• Report Date (Section B): 09/15/2021

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: 08/31/2023
• Device Model Number: 4245020W
• Device Catalogue Number: 4245020W
• Device Lot Number: 82199400
• Was Device Available for Evaluation?: No
• Type of Report(Section G): Initial
• Initial Date Received by Manufacturer: 08/25/2021
• Initial Report FDA Received Date: 09/15/2021
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1