| Catalog Number |
ENC452200 |
| Medical Device Problem Code |
Premature Activation (1484)
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| Health Effect - Clinical Code |
No Clinical Signs, Symptoms or Conditions (4582)
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| Date of Event |
03/13/2025
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Type of Reportable Event
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Malfunction
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Event or Problem Description
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As reported by the field, prior to use, the doctor opened the packaging of a 4.5 mmd 22 mml enterprise intracranial stent and removed the device from dispenser hoop, it was found that the stent was detached from the delivery wire.The device was not used in patient.The doctor switched to a new stent to complete the surgery.There was no patient injury reported as the device was not clinically used.Additional event information received on 21-mar-2025 indicated that there was no packaging issues.The inner pouch was securely sealed.The device was stored and prepped as per the instructions for use (ifu).
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Additional Manufacturer Narrative
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Manufacturer's ref.No: (b)(4).Information regarding patient weight, height, medical history, race, and ethnicity was not reported.Section e1: initial reporter phone: (b)(6).One (1) picture was included with the complaint report.The picture shows the stent body separated from the rest of the device, contained within the return pouch.The rest of the device is not visible.No other relevant details can be observed.A device history record (dhr) was performed and it indicated this product was final inspection tested at lake region medical and was determined to be acceptable.The reported complaint regarding a prematurely detached stent can be confirmed based on the condition observed in the picture.There is not enough information to determine any contributing factors to the issue experienced.There is no indication that the issue reported in the complaint results from a defect inherently related to the device.This investigation was performed based only on the picture provided.If the product is received after this investigation, an assessment will be performed as per the conditions of the device returned.As part of johnson & johnson medtech quality process all devices are manufactured, inspected, and released to approved specifications.Since there was no evidence to suggest the event was related to a manufacturing or design issue, no capa activity is required.Additional complaint information monitoring for potential safety signals is conducted through complaint trending as part of post-market surveillance.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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Additional Manufacturer Narrative
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Manufacturer ref#: (b)(4).Updated sections on this medwatch: b4, d9, g3, g6, h2, h3, h6 and h11.Complaint conclusion: as reported by the field, prior to use, the doctor opened the packaging of a 4.5mmd 22mml enterprise intracranial stent and removed the device from dispenser hoop, it was found that the stent was detached from the delivery wire.The device was not used in patient.The doctor switched to a new stent to complete the surgery.There was no patient injury reported as the device was not clinically used.Additional event information received on 21-mar-2025 indicated that there was no packaging issues.The inner pouch was securely sealed.The device was stored and prepped as per the instructions for use (ifu).One (1) picture was included with the complaint report.The picture shows the stent body separated from the rest of the device, contained within the return pouch.The rest of the device is not visible.No other relevant details can be observed.The device was returned to j&j medtech for further evaluation.A non-sterile 4.5mm x 22mm enterprise® vascular reconstruction device was received contained in the decontamination pouch.Upon receiving the device, visual inspection was performed, and the stent was detached from the delivery unit.Microscopic inspection was performed on the stent component.It was observed to be in good condition; there was no structural damage (i.E., no broken struts, no kinks); also, it was noted fully expanded, both ends can be noted as completely flared.The delivery wire was subjected to dimensional analysis and all measurements were found to be within specification, including those specifications that control the attachment and delivery of the stent.Therefore, device failure is not suspected to be a contributing factor.The customer complaint regarding a premature deployment of the stent during the removal from the hoop was confirmed due to the detached condition of the stent.However, the dimensional analysis performed showed no issues that could have resulted in the premature detachment of the stent.With the information available, the root cause of the failure encountered cannot be determined.It is possible that clinical and procedural factors, including device manipulation and operator's technique, may have contributed to the reported failure.At this time, there is no evidence to support that the issue reported in the complaint is a result of a defect inherently related to the device.Lake region medical did review the device history records relative to the manufacturing, inspecting and packaging of the lot 9309012.The history records indicate this product was final inspection tested at lake region medical and was determined to be acceptable.As part of the j&j medtech quality process, all devices are manufactured, inspected, and released to approved specifications.Since there was no evidence to suggest the event was related to a manufacturing or design issue, 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 recommendations: do not partially deploy the stent from the introducer.Confirm the tip of the delivery wire is entirely within the introducer.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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Search Alerts/Recalls
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