MAUDE Adverse Event Report: W. L. GORE & ASSOCIATES, INC. GORE® DRYSEAL FLEX INTRODUCER SHEATH; INTRODUCER, CATHETER

Catalog Number	DSF2233
Medical Device Problem Code	Patient Device Interaction Problem (4001)
Health Effect - Clinical Code	Vascular Dissection (3160)
Date of Event	03/19/2026
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
H6: a review of the manufacturing records for the device verified that the lot met all pre-release specifications.W.L.Gore & associates, inc.(gore) is submitting this report to comply with 21 c.F.R.Part 803, the medical device reporting regulation.This report is based upon information obtained by gore, which the company may not have been able to fully investigate or verify prior to the date the report was required by the fda.Blank fields present on this report include required fields and fields determined to be not applicable.Blank required fields indicate that the information was not provided, was deemed unavailable or was not applicable.This report does not constitute an admission or a conclusion by fda, gore, or its associates that the device, gore or its associates caused or contributed to the event described in the report.In particular, this report does not constitute a legal admission by anyone that the product described in this report has any defects or has malfunctioned, as defined from a legal standpoint.These words are included in the report and are fixed items for selection created by the fda, to categorize the type of event solely for the purpose of reporting pursuant to part 803.This statement should be included with any information or report disclosed to the public under the freedom of information act.
Event or Problem Description
The following information was reported to gore: on (b)(6) 2026, the patient underwent endovascular treatment of a thoracic aortic aneurysm, zone 2, using gore® tag® thoracic branch endoprosthesis.A 22 fr gore® dryseal flex introducer sheath was inserted through the left femoral artery.Following deployment of the stent graft, angiography revealed a dissection extending from the left common iliac artery to the left external iliac artery.As a treatment, a bare-metal stent was placed from the origin of the left external iliac artery.It was reported that resistance was encountered during sheath insertion.The sheath was advanced and retracted multiple times, and this repeated manipulation is considered the most likely cause of the iliac dissection.
Event or Problem Description
On (b)(6) 2026, the patient underwent endovascular treatment of a thoracic aortic aneurysm with aortic dissection, zone 2, using gore® tag® thoracic branch endoprosthesis.A 22 fr gore® dryseal flex introducer sheath was inserted through the left femoral artery.Following deployment of the stent graft, angiography revealed a dissection extending from the left common iliac artery to the left external iliac artery.As a treatment, a bare-metal stent was placed from the origin of the left external iliac artery.On (b)(6)2026, surgical repair was performed subsequently for the access vessel dissection that occurred during the procedure.It was reported that resistance was encountered during sheath insertion.The sheath was advanced and retracted multiple times, and this repeated manipulation is considered the most likely cause of the iliac dissection.
Additional Manufacturer Narrative
Emdr section h6, codes f1901, d15 and d1101 updated to reflect additional information.The event description in section b5 was also updated.

• Brand Name: GORE® DRYSEAL FLEX INTRODUCER SHEATH
• Common Device Name: INTRODUCER, CATHETER
• Manufacturer (Section D): W. L. GORE & ASSOCIATES, INC.; 1505 n. fourth street; flagstaff AZ 86004
• Manufacturer (Section G): MEDICAL PHOENIX 1 B/P; 32360 n. north valley parkway; phoenix AZ 85085
• Manufacturer Contact: rie kaba ; 1505 n. fourth street; flagstaff, AZ 86004 ; 9285263030
• MDR Report Key: 24812908
• Report Number: 3007284313-2026-04691
• Device Sequence Number: 6012104
• Product Code: DYB
• UDI-Device Identifier: 00733132630073
• UDI-Public: (01)00733132630073(17)280914
• Combination Product (Y/N): N
• Initial Reporter Country: JA
• PMA/510(K) Number: K160254
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): N
• Reporter Type: Manufacturer
• Report Source: Foreign,Company Representative
• Initial Reporter Occupation: Physician
• Type of Report: Initial
• Report Date (Section B): 04/08/2026

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?: No
• Operator of Device: Health Professional
• Device Catalogue Number: DSF2233
• 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: 03/19/2026
• Initial Report FDA Received Date: 04/08/2026
• Was Device Evaluated by Manufacturer? (Y/N): No
• Date Device Manufactured: 10/15/2025
• Is the Device Labeled for Single Use? (Y/N): Yes
• Usage of Device: Initial
• Patient Sequence Number: 1
• Outcome Attributed to Adverse Event: Required Intervention
• Patient Age: 84 YR
• Patient Sex: Female
• Patient Weight: 107 LB