MAUDE Adverse Event Report: COVIDIEN LP - SUPERDIMENSION INC UNKNOWN EMPRINT ANTENNA; System, image processing, radiological

Model Number UNKNOWN EMPRINT ANTENNA

Device Problem Adverse Event Without Identified Device or Use Problem (2993)

Patient Problems Hematoma (1884); Pain (1994); Pleural Effusion (2010); Thrombosis/Thrombus (4440); Appropriate Clinical Signs, Symptoms, Conditions Term / Code Not Available (4581)

Event Date 11/01/2022

Event Type  Injury  

Manufacturer Narrative

Unknown cool tip elecrtrode (lot#unknown) unknown cool tip elecrtrode (lot#unknown) unknown emprint antenna (lot#unknown) title: single-session transarterial chemoembolization combined with percutaneous thermal ablation in liver metastases 3cm or larger.Source: diagnostic and interventional imaging 103 (2022) 516-523.November 2022.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.If information is provided in the future, a supplemental report will be issued.

Event Description

According to the literature source of study performed between april 2003 to january 2021, a retrospective study analyzed outcomes of 39 patients with liver metastasis 3 cm in diameter or greater who underwent a treatment that combined trans arterial chemoembolization (tace) with percutaneous thermal ablation using microwave ablation (mwa), or cryoablation.Mwa was performed with either the emprint system or competitor devices.Using the ctcae complication grading scale, the authors reported 4 grade 2 complications including pleural effusion requiring drainage, segmental portal vein thrombosis with subsequent segmental liver infarction, and a subcapsular hematoma.A total of 103 patients underwent a treatment that combined tace and percutaneous thermal ablation.The authors do not provide any additional details regarding these complications or interventions required.The article does not specify which device is associated with the reported complications.

• Brand Name: UNKNOWN EMPRINT ANTENNA
• Type of Device: System, image processing, radiological
• Manufacturer (Section D): COVIDIEN LP - SUPERDIMENSION INC; 161 cheshire lane, suite 100; plymouth MN 55441
• Manufacturer (Section G): COVIDIEN LP - SUPERDIMENSION INC; 161 cheshire lane, suite 100; plymouth MN 55441
• Manufacturer Contact: justin ellis ; 8200 coral sea st ne; mounds view, MN 55112 ; 7635265677
• MDR Report Key: 16096941
• MDR Text Key: 306645489
• Report Number: 3004962788-2023-00001
• Device Sequence Number: 1
• Product Code: LLZ
• Combination Product (y/n): N
• Reporter Country Code: FR
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Foreign,Literature,Health Professional
• Reporter Occupation: Other
• Type of Report: Initial
• Report Date: 01/04/2023

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 01/04/2023
• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: Yes
• Device Operator: Health Professional
• Device Model Number: UNKNOWN EMPRINT ANTENNA
• Device Catalogue Number: UNKNOWN EMPRINT ANTENNA
• Was Device Available for Evaluation?: No
• Date Manufacturer Received: 12/15/2022
• Is the Device Single Use?: Yes
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: Initial
• Patient Sequence Number: 1
• Patient Outcome(s): Required Intervention
• Patient Sex: Female