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As reported by the field, during a coil embolization, a non j&j microcatheter (mc) was in place and a galaxy g3 mini 2.5mm x 5.5cm coil (glm925055, 30824771) was delivered to target site.The coil was filled in the aneurysm and tried to detach, but the coil was unable to detach.The doctor inspected indicator light of the detachment control box (dcb) and connect cable, and observed all were under good condition.The doctor pressed the detachment button to detach the coil again, but the coil still failed to detach.Then the doctor only retracted the coil alone and switched to a second new coil to fill the aneurysm and be detached successfully.Later the third coil, a galaxy g3 mini 3mm x 6cm (glm930060, 30889366) had the same issue when it was to be detached, the doctor only retracted the third coil alone and switched to a fourth new coil to complete the surgery.The microcatheter was not replaced.There was no patient injury reported.Additional event information received on 22-jan-2025 indicated that a pre-deployment electrical testing was performed.The same dcb and control cable were successfully with subsequent coils.The coils were still attached to the coil delivery system when removed from the patient.The coils did not stretch or damaged when removed.The event was prolonged for approximately 5 minutes due to the events, the delay was not clinically significant.
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Product complaint # (b)(4) information regarding patient weight, height, medical history, race, and ethnicity was not reported.Section d2b ¿ procode: krd/hcg.Section e1.Initial reporter phone: (b)(6).Section h3 - the device is available to be returned for evaluation and testing.However, it has not been received to date.If the device returns, a device investigation will be performed.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.
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Product complaint # (b)(4).Updated sections on this medwatch: b4, d9, g3, g6, h2, h3, h6 and h11.Complaint conclusion: as reported by the field, during a coil embolization, a non j&j microcatheter (mc) was in place and a galaxy g3 mini 2.5mm x 5.5cm coil (glm925055, 30824771) was delivered to target site.The coil was filled in the aneurysm and tried to detach, but the coil was unable to detach.The doctor inspected indicator light of the detachment control box (dcb) and connect cable, and observed all were under good condition.The doctor pressed the detachment button to detach the coil again, but the coil still failed to detach.Then the doctor only retracted the coil alone and switched to a second new coil to fill the aneurysm and be detached successfully.Later the third coil, a galaxy g3 mini 3mm x 6cm (glm930060, 30889366) had the same issue when it was to be detached, the doctor only retracted the third coil alone and switched to a fourth new coil to complete the surgery.The microcatheter was not replaced.There was no patient injury reported.Additional event information received on 22-jan-2025 indicated that a pre-deployment electrical testing was performed.The same dcb and control cable were successfully with subsequent coils.The coils were still attached to the coil delivery system when removed from the patient.The coils did not stretch or damaged when removed.The event was prolonged for approximately 5 minutes due to the events, the delay was not clinically significant.A non-sterile galaxy g3 mini 2.5mm x 5.5cm coil was received contained in the decontamination pouch.Upon receiving the device, visual inspection was performed, and the embolic coil was severely stretched.The blue fiber was visible and the embolic coil still remained attached to the resistance heating (rh).The electrical resistance of the galaxy g3 device was measured with a multimeter, it measured 54.8 ohms o, which is within the specification range between 48.5 ohms o ¿ 56.0 ohms o.Also, the device was connected to a lab sample detachment control box (dcb), and to a lab sample enpower control cable, and the power was turned on.The system ready light was illuminating.Then, the detach button was pressed, and a beep sound was heard.The coil was successfully detached from the unit.A manufacturing record evaluation was performed for the finished device 30824771 number, and no non-conformances related to the malfunction were identified.The issue documented that the coil failed to detach could not be confirmed since the device met the electrical specification range.There may have been other circumstances or issues that occurred during the use of the device that could not be replicated in the lab setting.The instructions for use (ifu) provide proper handling instructions for the device to prevent such issues from occurring.According to the risk documentation, failure to detach is a potential issue that can occur during the coil detachment due to a detachment cycle not being initiated as a result of the dpu wire detachment zone/extended coil being positioned beyond the microcatheter tip, which can result in reported failure.The stretched condition of the embolic coil was not originally reported, and the severity of the condition could had been identified by the physician.Due to this, the stretched condition could be the result of the post-handling of the coil when it was being removed; therefore, it is not considered related to the failure reported.As part of the j&j medtech quality process, all devices are manufactured, inspected, and released to approved specifications.Therefore, no capa activity is required.It should be noted that product failure could be caused by multiple factors.The instructions for use (ifu) do contain the following recommendation: verify that the microcoil delivery system is fully connected, and no faults are indicated on the dcb.If a fault exists, reseat all connections between the dpu, the dcb, and the connecting cable.If a fault still persists, replace the connecting cable.If this does not correct the error, replace the dcb.If the microcoil delivery system still continues to have a fault, retrieve the microcoil, re sheathing the microcoil system, and replace it with a new microcoil system.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.A supplemental report will be submitted if new facts arise which materially alter information submitted in a previous mdr report.
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