MAUDE Adverse Event Report: STRYKER NEUROVASCULAR CORK TARGET 360 STANDARD 7MM X 20CM; DEVICE, NEUROVASCULAR EMBOLIZATION

Model Number	M0035467200
Medical Device Problem Code	Adverse Event Without Identified Device or Use Problem (2993)
Health Effect - Clinical Codes	Visual Impairment (2138); Cognitive Changes (2551)
Date of Event	12/10/2021
Type of Reportable Event	Serious Injury
Event or Problem Description
It was reported in a clinical trial procedure to treat a right posterior communicating artery aneurysm, the patient had hemianopia and delirium.On imaging, occipital micro embolic infarcts were seen which resulted in prolonged hospitalization for the patient.The event was treated with physiotherapy and oral olanzapin 5 mg for delirium for 5 days and recovered.In the physician's opinion, the event was possibly related to the subject device and other stryker devices used in the procedure.
Additional Manufacturer Narrative
Device is implanted in patient.
Event or Problem Description
It was reported in a clinical trial procedure to treat a right posterior communicating artery aneurysm, the patient had hemianopia and delirium.On imaging, occipital micro embolic infarcts were seen which resulted in prolonged hospitalization for the patient.The event was treated with physiotherapy and oral olanzapin 5 mg for delirium for 5 days and recovered.In the physician's opinion, the event was possibly related to the subject device and other stryker devices used in the procedure.
Additional Manufacturer Narrative
H4 manufacturing date ¿ added.D4 expiration date - added.The subject device is not available; therefore, visual and functional testing as well as physical analysis cannot be performed.Due to the automated mes system there are controls in the manufacturing process to ensure the product met specifications upon release.The reported event is covered in the device directions for use (dfu).As well, the risk of the reported event is documented in the risk documentation and there are current controls to mitigate the risk of the as reported event.The reported complaint could not be confirmed, and it could not be definitively determined if the device failed to meet specifications because the product was not returned.It was reported that in a clinical trial, the patient had hemianopia and delirium post procedure with the subject coil.The ae was treated with physiotherapy and oral olanzapin 5 mg for delirium for 5 days.Based upon medical review, the harm observed in this complaint is anticipated in nature as per the device risk assessment.As a product related root cause does not apply and the issue is due to a known physiological effect of the procedure and/or patient condition noted within the dfu, product labeling and/or risk documentation files, an assignable cause of anticipated procedural complication will be assigned to this complaint.H3 other text : device is implanted in patient.

• Brand Name: TARGET 360 STANDARD 7MM X 20CM
• Common Device Name: DEVICE, NEUROVASCULAR EMBOLIZATION
• Manufacturer (Section D): STRYKER NEUROVASCULAR CORK; ida industrial estate; model farm road; cork NA ; EI NA
• Manufacturer (Section G): STRYKER NEUROVASCULAR CORK; ida industrial estate; model farm road; cork NA ; EI NA
• Manufacturer Contact: tara lopez ; 47900 bayside parkway; fremont, CA 94538 ; 5104132500
• MDR Report Key: 13272011
• Report Number: 3008881809-2022-00017
• Device Sequence Number: 20071313
• Product Code: HCG
• UDI-Device Identifier: 04546540676306
• UDI-Public: 04546540676306
• Combination Product (Y/N): N
• Initial Reporter Country: SZ
• PMA/510(K) Number: K153658
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2021
• Reporter Type: Manufacturer
• Report Source: Health Professional
• Initial Reporter Occupation: Physician
• Type of Report: Initial,Followup
• Report Date (Section B): 04/25/2022

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: No
• Operator of Device: Health Professional
• Device Expiration Date: 08/11/2023
• Device Model Number: M0035467200
• Device Catalogue Number: M0035467200
• Device Lot Number: 22373627
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Type of Report(Section G): Initial
• Initial Date Received by Manufacturer: 12/22/2021
• Supplement Date Received by Manufacturer: 03/30/2022
• Initial Report FDA Received Date: 01/17/2022
• Supplement Report FDA Received Date: 04/25/2022
• Was Device Evaluated by Manufacturer? (Y/N): Device Not Returned to Manufacturer
• Date Device Manufactured: 08/12/2020
• Is the Device Labeled for Single Use? (Y/N): Yes
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Usage of Device: Initial
• Patient Sequence Number: 1
• Concomitant Medical Products and Therapy/Usage Dates: EXCELSIOR XT27 1 TIP STRAIGHT 150CM X 6CM; SL-10 2 TIP STRAIGHT 150CM X 6CM; SURPASS EVOLVE 4.5MM X 17MM - IDE; SYNCHRO 0.014IN X 200CM; SYNCHRO 0.014IN X 300CM; TARGET 360 SOFT 5MM X 15CM; TARGET 360 SOFT 6MM X 20CM; TARGET 360 STANDARD 6MM X 15CM
• Outcome Attributed to Adverse Event: Required Intervention; Other
• Patient Age: 71 YR
• Patient Sex: Female