MAUDE Adverse Event Report: BOSTON SCIENTIFIC CORPORATION SENSATION SHORT THROW; SNARE, FLEXIBLE

Model Number	M00562650
Medical Device Problem Codes	Failure to Cut (2587); Adverse Event Without Identified Device or Use Problem (2993)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	09/30/2024
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
Block h6: imdrf device code a050702 captures the reportable event of loop failure to cut.
Event or Problem Description
It was reported to boston scientific corporation that a sensation short throw was used for a polyp in the colon for a polypectomy procedure performed on (b)(6) 2024.During the procedure, on its first cut it loses quality and does not cut.The procedure was completed with another sensation short throw.There were no patient complications reported as a result of this event.
Additional Manufacturer Narrative
Block h6: imdrf device code a050702 captures the reportable event of loop failure to cut.Block h11: investigation results the returned sensation snare was analyzed, a visual was performed, and it was found that the working length (tip of the sheath) was torn.During functional inspection, the device was extended and retracted in the 10- inch loop fixture, and the loop could extend properly without any issue.A continuity and electrical test was performed, and it was noted that the device was found to be within specification.No other problems with the device were noted.No other problems with the device were noted.The reported complaint of loop failure to cut was unable to be confirmed.It is likely that this problem occurred due to how the device was handled and manipulated, which may have caused the reported and encountered failures.Excessive manipulation of the device without enough care could have induced the defects found.Therefore, the most probable root cause of this complaint is no problem detected.
Event or Problem Description
It was reported to boston scientific corporation that a sensation short throw was used for a polyp in the colon for a polypectomy procedure performed on (b)(6) 2024.During the procedure, on its first cut it loses quality and does not cut.The procedure was completed with another sensation short throw.There were no patient complications reported as a result of this event.

• Brand Name: SENSATION SHORT THROW
• Common Device Name: SNARE, FLEXIBLE
• Manufacturer (Section D): BOSTON SCIENTIFIC CORPORATION; 300 boston scientific way; marlborough MA 01752
• Manufacturer (Section G): BOSTON SCIENTIFIC CORPORATION; 2546 calle primera; alajuela ; CS
• Manufacturer Contact: arlene acevedo gutierrez ; 300 boston scientific way; marlborough, MA 01752 ; 7877968283
• MDR Report Key: 20536271
• Report Number: 3005099803-2024-05326
• Device Sequence Number: 8325253
• Product Code: FDI
• UDI-Device Identifier: 08714729748069
• UDI-Public: 08714729748069
• Combination Product (Y/N): N
• Initial Reporter Country: CO
• PMA/510(K) Number: K941750
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): Unknown
• Reporter Type: Manufacturer
• Report Source: Other,Foreign,Health Professional,Company Representative
• Initial Reporter Occupation: Physician
• Type of Report: Initial,Followup
• Report Date (Section B): 06/06/2025

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: 08/21/2026
• Device Model Number: M00562650
• Device Catalogue Number: 6265S
• Device Lot Number: 0032272651
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Is the Reporter a Health Professional?: Yes
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 10/01/2024
• Supplement Date Received by Manufacturer: 05/13/2025
• Initial Report FDA Received Date: 10/25/2024
• Supplement Report FDA Received Date: 06/06/2025
• Was Device Evaluated by Manufacturer? (Y/N): Yes
• Date Device Manufactured: 08/22/2023
• 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