MAUDE Adverse Event Report: MEDOS INTERNATIONAL SARL GALAXY G3 4MM X 10CM; NEUROVASCULAR EMBOLIZATION DEVICE

Model Number	GLY120410
Medical Device Problem Code	Device Difficult to Setup or Prepare (1487)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	12/07/2022
Type of Reportable Event	Malfunction
Event or Problem Description
As reported by the field, coil embolization was performed by selecting each branch from multiple branches.It is unknown which arteries were treated.The complaint coils were used from a microcatheter (phenom) but re-sheathing was impossible.The complaint coil galaxy g3 6mm x 15cm (gly120615/ 30670813) was the first coil and another complaint coil galaxy g3 4mm x 10cm (gly120410/ 30628983) was the second coil used.Another g3 coil (4mm x 10cm) was used as a replacement coil and used without any problems.Additional event information states that no damage was noted in the device.Resistance was not felt at any time during the advancement of the coil through the microcatheter.It was not necessary to remove the microcatheter.Based on the product analysis of the device received, the embolic coil is stretched and kinked.
Additional Manufacturer Narrative
Product complaint#: (b)(4).The purpose of this mdr submission is to report the findings of the device investigation.The embolic coil is stretched and kinked.The findings meet us regulatory reporting criteria.Initial reporter phone: (b)(6) a non-sterile galaxy g3 4mm x 10cm was received contained in the decontamination pouch.Upon receiving the device, a visual inspection was performed, and it was noted that the coil is protruding through the introducer.The device was inspected under microscopic magnification, and it was found that the introducer was kinked at the point where the core wire protrudes.Also, the embolic coil was inspected, and it was found to be stretched and kinked; it remains attached to the resistance heating (rh).No other damages were found in the device.The issue documented in the complaint that coil resheathing was not possible was confirmed since the damages noted in the in the introducer and coil components prevented the device from being resheathed.The resheathing tool could not be advanced past the kink damage observed in the introducer, resulting in coil protrusion due to manipulation and excessive force that may have been inadvertently applied.Coil kinking and stretching are known potential issues associated with the use of this device.The instructions for use (ifu) provide proper handling instructions for the device to prevent such issues from occurring.Kinking and stretching can occur during procedure handling where force may have been inadvertently applied.According to the risk documentation, friction is a potential failure mode that can occur during microcoil re-sheathing; friction can cause force to be inadvertently been applied, resulting in the damages observed.Since the procedural situation that led to the coil being re-sheathed is unknown, there could be other factors that may have contributed to the issue encountered during the procedure.There is no indication that the issue reported in the complaint is a result of a defect inherently related to the device.A manufacturing record evaluation was performed, and no non-conformances related to the reported complaint condition were identified.It should be noted that multiple factors could cause product failure.The instructions for use (ifu) does contain the following recommendations: do not fasten the rhv valve too tightly around the introducer sheath since excessive pressure may cause damage to the introducer sheath and/or the microcoil as it is advanced into the infusion microcatheter.Additionally, if the introducer tip and microcatheter hub are misaligned, damage may occur to the microcoil as it passes through this transition.During re-sheathing: pulling the exposed microcoil through the rhv grommet may damage the coil.As part of the cerenovus quality process, all devices are manufactured, inspected, and released to approved specifications.As part of the post market surveillance program, information from this complaint is trended to identify statistical signals for consideration of further correction action.Since there was no evidence to suggest the event was related to a manufacturing or design issue, no corrective actions will be taken at this time.Missing information from this report is identified as blank; this information was not provided in the reported event or available at the time of report submission.This report is being submitted pursuant to the provisions of 21 cfr, part 803 (and/or part 4, as applicable).This report may be based on information which has not been investigated or verified prior to the required reporting date.This report does not reflect a conclusion by cerenovus, or its employees that the report constitutes an admission that the product, cerenovus, or its employees caused or contributed to the potential event described in this report.If information is obtained that was not available for the initial report, a follow-up report will be filed as appropriate.A supplemental report will be submitted if new facts arise which materially alter information submitted in a previous mdr report.

• Brand Name: GALAXY G3 4MM X 10CM
• Common Device Name: NEUROVASCULAR EMBOLIZATION DEVICE
• Manufacturer (Section D): MEDOS INTERNATIONAL SARL; chemin-blanc 38; le locle neuchatel CH-24 00; SZ CH-2400
• Manufacturer (Section G): CODMAN & SHURTLEFF, INC. (FREMONT); 47709 fremont blvd; fremont CA 94538
• Manufacturer Contact: kate karberg ; 31 technology dr; irvine, CA 92618 ; 3035526892
• MDR Report Key: 16303246
• Report Number: 3008114965-2023-00094
• Device Sequence Number: 6185616
• Product Code: KRD
• UDI-Device Identifier: 10886704077473
• UDI-Public: 10886704077473
• Combination Product (Y/N): N
• Initial Reporter Country: JA
• PMA/510(K) Number: K150319
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): Unknown
• Reporter Type: Manufacturer
• Report Source: Foreign,Health Professional
• Initial Reporter Occupation: Physician
• Type of Report: Initial
• Report Date (Section B): 02/06/2023

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: 07/31/2024
• Device Model Number: GLY120410
• Device Catalogue Number: GLY120410
• Device Lot Number: 30628983
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 01/10/2023
• Is the Reporter a Health Professional?: Yes
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 02/03/2023
• Initial Report FDA Received Date: 02/06/2023
• Was Device Evaluated by Manufacturer? (Y/N): Yes
• Date Device Manufactured: 08/11/2021
• 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: GALAXY G3 6MM X 15CM; PHENOM MICROCATHETER
• Patient Sex: Unknown