MAUDE Adverse Event Report: US ENDOSCOPY PADLOCK CLIP

Model Number	C910001
Medical Device Problem Code	Failure to Fire (2610)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	10/22/2024
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
The padlock clip is used for clip placement within the gastrointestinal tract and consists of a single-use clip within a delivery system.The clip component of the device is within a delivery housing which is mounted and secured at the distal tip on the outside surface of a flexible endoscope.A linking cable rests along the outside of the endoscope's insertion tube and connects the delivery housing/clip to a control handle and thumb actuator outside of the patient.The user depresses the thumb actuator to deploy the clip.The device subject of the reported event was not returned to steris for evaluation as the user facility discarded it.An exact cause could not be determined as the device was not returned to steris for evaluation.The dhr for the subject lot was reviewed and confirmed the lot was manufactured according to specifications; no abnormalities were noted.User facility personnel stated that there were no issues noted during their inspection of the device prior to use.Based on our investigation and similar events where the device was evaluated, improper handling by user facility personnel of the device and linking cable which is part of the mechanism to deploy the clip was likely the cause of the reported event.The instructions for use (ifu) include the following statement about proper handling of the linking cable, "avoid bending the linking cable too aggressively or using a grasping/clamping device on the linking cable as it can create a "kink" and/or disable device function." additionally, the ifu includes instructions to inspect the linking cable for kinks prior to use, specifically, "inspect the entire padlock clip defect closure system for kinks in the linking cable or other damage to the delivery housing, control handle body, and the thumb actuator (cracks, breaks, protruding or missing parts).If damage is evident do not use this product and contact your local product specialist or customer service representative." no additional issues have been reported.
Event or Problem Description
The distributor reported that their padlock clip defect closure system was unable to deploy the clip due to a damaged handle.No report of injury of procedure delay.

• Brand Name: PADLOCK CLIP
• Common Device Name: PADLOCK CLIP
• Manufacturer (Section D): US ENDOSCOPY; 5976 heisley road; mentor 44060
• Manufacturer (Section G): US ENDOSCOPY; 5976 heisley road; mentor OH 44060
• Manufacturer Contact: coletta cohara ; 5976 heisley road; mentor 44060 ; 4404130648
• MDR Report Key: 22317787
• Report Number: 1528319-2025-00049
• Device Sequence Number: 9024033
• Product Code: PKL
• UDI-Device Identifier: 00724995184247
• UDI-Public: (01)00724995184247(11)230530(17)260530(10)5784402
• Combination Product (Y/N): N
• Initial Reporter Country: IN
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): N
• Reporter Type: Manufacturer
• Report Source: Distributor
• Initial Reporter Occupation: Other Health Care Professional
• Type of Report: Initial
• Report Date (Section B): 06/24/2025

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: 05/30/2026
• Device Model Number: C910001
• Device Catalogue Number: C910001
• Device Lot Number: (10)5784402
• 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: 06/11/2025
• Initial Report FDA Received Date: 06/24/2025
• Was Device Evaluated by Manufacturer? (Y/N): No
• Date Device Manufactured: 05/30/2023
• 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