MAUDE Adverse Event Report: ASAHI INTECC CO., LTD. MIRACLEBROS 6; PTCA GUIDE WIRE

Model Number	AG14M360
Medical Device Problem Code	Material Separation (1562)
Health Effect - Clinical Code	Device Embedded In Tissue or Plaque (3165)
Date of Event	05/27/2025
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
Manufacturing site: toyoflex cebu corporation, cebu, philippines, registration number: 3016119728.Device evaluation could not be performed because the affected devices were discarded and not returned from the user facility.Lot history review revealed no anomaly relating to the reported event.No other similar product experience report was received from this lot.Based on the obtained information, results of lot history review, and referring to known similar events, it was presumed that tensional stress and/or torsional stress generated with guide wire manipulation might have been locally accumulated to the subject miraclebros 6 guide wire while its distal segment had been temporarily caught in the subintimal space.Consequently, the distal segment of the guide wire was detached.It was concluded that the reported event was not attributed to the product quality.Capa: no capa will be taken.The instructions for use (ifu) states: [warnings]: observe movement of this guide wire in the vessels.Before this guide wire is moved or torqued, the tip movement should be examined and monitored under fluoroscopy.Do not move or torque the guide wire without observing corresponding movement of the tip; otherwise, the guide wire may be damaged and/or trauma may occur.In addition, ensure that the distal tip of this guide wire and its location in the vessel are visible during manipulations of the guide wire.Never push, auger, withdraw, or torque this guide wire that meets resistance.Torquing or pushing this guide wire against resistance may cause damage and/or tip separation of this guide wire or direct damage to a vessel.Resistance may be felt and/or observed under fluoroscopy by noting any buckling of the guide wire.If the prolapse of the guide wire tip is observed, do not allow the tip to remain in a prolapsed position; otherwise damage to the guide wire may occur.Determine the cause of resistance under fluoroscopy and take any necessary remedial action.If resistance is felt due to spasm, bending of the guide wire, or due to trap while operating this guide wire in the blood vessel or removing it, do not torque and/or pull the guide wire itself.Stop the procedure.Determine the cause of resistance under fluoroscopy and take appropriate remedial action.If the guide wire is moved excessively, it may break or become damaged, which may cause blood vessel injury or result in fragments being left inside the vessel.[malfunction and adverse effects]: separation of the guide wire.
Event or Problem Description
It was reported that an atherectomy was performed for a long chronic total occlusion (cto) lesion of approximately 2-3cm in length in the peroneal artery.An asahi miracle 6 guide wire was used after an asahi crosslead guide wire, an asahi gladius mongo es guide wire, and an asahi astato xs 20 guide wire were used to access the distal cap of the cto after its proximal cap was crossed.The subject miracle 6 guide wire was fractured in the subintimal space.After the atherectomy to the proximal lesion was successfully completed, another unit of miracle 6 guide wire was used to successfully complete the procedure.The physician concluded that the guide wire fragment would be left in situ.It was informed that there were no additional treatments provided to the patient, who was discharged on the same day of the procedure.

• Brand Name: MIRACLEBROS 6
• Common Device Name: PTCA GUIDE WIRE
• Manufacturer (Section D): ASAHI INTECC CO., LTD.; 3-100 akatsuki-cho; seto, aichi 489-0 071; JA 489-0071
• Manufacturer (Section G): ASAHI INTECC CO., LTD.; 3-100 akatsuki-cho; seto, aichi 489-0 071; JA 489-0071
• Manufacturer Contact: yukimi nagumo ; 3-100 akatsuki-cho; seto, aichi 489-0-071 ; JA 489-0071
• MDR Report Key: 22147322
• Report Number: 3003775027-2025-00156
• Device Sequence Number: 8477999
• Product Code: DQX
• UDI-Device Identifier: 04547327056106
• UDI-Public: (01)04547327056106(17)270630(10)240723A12F
• Combination Product (Y/N): N
• Initial Reporter State: TX
• Initial Reporter Country: US
• PMA/510(K) Number: K171933
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): N
• Reporter Type: Manufacturer
• Report Source: Foreign,Distributor
• Initial Reporter Occupation: Physician
• Type of Report: Initial
• Report Date (Section B): 06/05/2025

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: Yes
• Operator of Device: Health Professional
• Device Model Number: AG14M360
• Device Lot Number: 240723A12F
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 05/29/2025
• Initial Report FDA Received Date: 06/05/2025
• Was Device Evaluated by Manufacturer? (Y/N): No
• 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
• Outcome Attributed to Adverse Event: Disability
• Patient Age: 69 YR
• Patient Sex: Female