MAUDE Adverse Event Report: BIOTRONIK AG, BUELACH, SWITZERLAND PASSEO-35 XEO 5/40/90; CATHETER, ANGIOPLASTY, PERIPHERAL, TRANSLUMINAL

Model Number	428788
Medical Device Problem Codes	Material Puncture/Hole (1504); Material Rupture (1546)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	03/11/2024
Type of Reportable Event	Malfunction
Event or Problem Description
A passeo-35 xeo was selected for a treatment in the left a.Femoralis.During the intervention, the balloon burst at a pressure of 10 bar within the femoral artery.
Additional Manufacturer Narrative
The returned device was subjected to a technical analysis and the corresponding production documentation was reviewed to establish whether a deviation from the manufacturing process could be the cause for the reported event.The technical investigation of the returned device revealed that the balloon has been inflated and was deflated in the as-returned state.Upon inflation a fine jet of water was seen to emerge from the proximal part of the balloon.Microscopic inspection revealed a small pinhole in the balloon surface about 12 mm distal to the proximal x-ray marker.Scratches were observed in close vicinity of the pinhole.It seems likely that the damage of the balloon surface was caused by a hard, sharp-edged object such as e.G., anatomical structure.Review of the production documentation confirmed that the device was manufactured according to specifications and passed all in-process and final inspections.In addition to visual inspections each product is tested for air tightness by means of a pressure test and a helium leak test.We can therefore confirm that the product was delivered in a leak-proof condition.Based on the conducted investigations, no manufacturing or material related root cause could be determined.The root cause is most likely related to the patients anatomy.
Additional Manufacturer Narrative
Corrected the initial reporter information.Reference capa# (b)(4).The returned device was subjected to a technical analysis and the corresponding production documentation was reviewed to establish whether a deviation from the manufacturing process could be the cause for the reported event.The technical investigation of the returned device revealed that the balloon has been inflated and was deflated in the as-returned state.Upon inflation a fine jet of water was seen to emerge from the proximal part of the balloon.Microscopic inspection revealed a small pinhole in the balloon surface about 12 mm distal to the proximal x-ray marker.Scratches were observed in close vicinity of the pinhole.It seems likely that the damage of the balloon surface was caused by a hard, sharp-edged object such as e.G., anatomical structure.Review of the production documentation confirmed that the device was manufactured according to specifications and passed all in-process and final inspections.In addition to visual inspections each product is tested for air tightness by means of a pressure test and a helium leak test.We can therefore confirm that the product was delivered in a leak-proof condition.Based on the conducted investigations, no manufacturing or material related root cause could be determined.The root cause is most likely related to the patient's anatomy.

• Brand Name: PASSEO-35 XEO 5/40/90
• Common Device Name: CATHETER, ANGIOPLASTY, PERIPHERAL, TRANSLUMINAL
• Manufacturer (Section D): BIOTRONIK AG, BUELACH, SWITZERLAND; ackerstrasse 6; buelach CH-81 80; CH CH-8180
• Manufacturer Contact: 6024 jean road; lake oswego, OR 97035 ; 8772459800
• MDR Report Key: 19061564
• Report Number: 1028232-2024-01927
• Device Sequence Number: 6752127
• Product Code: LIT
• UDI-Device Identifier: 07640130451599
• UDI-Public: (01)07640130451599(17)2701
• Combination Product (Y/N): N
• Initial Reporter Country: DE
• PMA/510(K) Number: K142379
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: Other,Foreign,User Facility,Company Representative
• Initial Reporter Occupation: Other Health Care Professional
• Type of Report: Initial,Followup,Followup
• Report Date (Section B): 10/28/2024

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: 428788
• Device Catalogue Number: 428788
• Device Lot Number: 01241138
• Was Device Available for Evaluation?: Yes
• Is the Reporter a Health Professional?: Yes
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 04/08/2024
• Supplement Date Received by Manufacturer: 05/23/2024; 10/28/2024
• Initial Report FDA Received Date: 04/08/2024
• Supplement Report FDA Received Date: 05/24/2024; 10/29/2024
• Was Device Evaluated by Manufacturer? (Y/N): Yes
• Date Device Manufactured: 01/31/2024
• 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
• Patient Sex: Unknown