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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: BARD PERIPHERAL VASCULAR, INC. ULTRAVERSE PTA DILATATION CATHETER PTA BALLOON CATHETER

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BARD PERIPHERAL VASCULAR, INC. ULTRAVERSE PTA DILATATION CATHETER PTA BALLOON CATHETER Back to Search Results
Catalog Number U357554
Device Problem Leak/Splash (1354)
Patient Problem No Patient Involvement (2645)
Event Date 12/04/2015
Event Type  Malfunction  
Manufacturer Narrative

No hospital/medical records or medical images have been made available to the manufacturer. As the lot number for the device is unknown, a review of the device history records cannot be performed. The device has been returned to the manufacturer for evaluation. The investigation of the reported event is currently underway. The information provided by bard represents all of the known information at this time. Despite good faith efforts to obtain additional information, the complainant / reporter was unable or unwilling to provide any further patient, product, or procedural details to bard.

 
Event Description

It was reported that a pta balloon allegedly leaked at the hub during flushing/preparation. Reportedly, another balloon was used to complete the procedure. There was no patient involement.

 
Manufacturer Narrative

Manufacturing review: the lot number was provided and the lot device history records were reviewed. The lot met all release criteria. There was nothing found to indicate there was a manufacturing related cause for this event. Visual/microscopic inspection: the sample was returned. The balloon was not in its original folded configuration. No anomalies were noted to the strain relief or the y-hub. Functional/performance evaluation: the patency of the lumen was tested using an 0. 035¿ guidewire and passed without issue. The inflation hub was connected to an inflation device and the balloon was inflated with water. During inflation, water was observed leaking out of the distal end of the strain relief. The strain relief was removed and a partial circumferential catheter shaft break was found just distal to the y-hub. Sanding marks were noted on the catheter underneath the strain relief and at the location of the break. Medical records review: medical records were not provided for review. Image/photo review: images/photos were not provided for review. Conclusion: the investigation is confirmed for a partial circumferential catheter shaft break just distal to the y-hub, resulting in the reported leak. Excessive sanding of the catheter under the strain relief is the root cause for the partial break in the catheter. Labeling review: the current ifu (instructions for use) states: precautions: carefully inspect the catheter prior to use to verify that catheter has not been damaged during shipment and that its size, shape, and condition are suitable for the procedure for which it is to be used. Do not use if product damage is evident. Use of the ultraverse 035 pta dilatation catheter: position the balloon relative to the lesion to be dilated, ensure the guidewire is in place, and inflate the balloon to the appropriate pressure. The information provided by bard represents all of the known information at this time. Despite good faith efforts to obtain additional information, the complainant / reporter was unable or unwilling to provide any further patient, product, or procedural details to bard.

 
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Brand NameULTRAVERSE PTA DILATATION CATHETER
Type of DevicePTA BALLOON CATHETER
Manufacturer (Section D)
BARD PERIPHERAL VASCULAR, INC.
1625 west 3rd st.
tempe AZ 85281
Manufacturer (Section G)
CLEARSTREAM TECHNOLOGIES LTD.
moyne upper
enniscorthy, co. wexford
EI
Manufacturer Contact
judith ludwig
1625 west 3rd st.
tempe, AZ 85281
4803032689
MDR Report Key5331026
MDR Text Key34525851
Report Number2020394-2015-02072
Device Sequence Number1
Product Code LIT
Combination Product (Y/N)N
Reporter Country CodeUS
PMA/PMN NumberK142261
Number of Events Reported1
Summary Report (Y/N)N
Report Source Manufacturer
Source Type COMPANY REPRESENTATIVE,HEALTH
Reporter Occupation
Type of Report Initial,Followup
Report Date 12/04/2015
1 Device Was Involved in the Event
0 PatientS WERE Involved in the Event:
Date FDA Received12/28/2015
Is This An Adverse Event Report? No
Is This A Product Problem Report? Yes
Device Operator HEALTH PROFESSIONAL
Device EXPIRATION Date09/30/2016
Device Catalogue NumberU357554
Device LOT NumberUNKNOWN
Was Device Available For Evaluation? Device Returned To Manufacturer
Date Returned to Manufacturer12/22/2015
Is The Reporter A Health Professional? Yes
Was the Report Sent to FDA?
Event Location No Information
Date Manufacturer Received03/22/2016
Was Device Evaluated By Manufacturer? Yes
Date Device Manufactured11/07/2014
Is The Device Single Use? Yes
Is this a Reprocessed and Reused Single-Use Device? No
Type of Device Usage Initial

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