MAUDE Adverse Event Report: OLYMPUS MEDICAL SYSTEMS CORP. SINGLE USE BALLOON DILATOR V (WITH KNIFE)

Model Number BD-VC431Q-1840-20

Device Problem Break (1069)

Patient Problem No Consequences Or Impact To Patient (2199)

Event Date 09/26/2016

Event Type  malfunction  

Manufacturer Narrative

The subject product was returned to omsc for investigation.The investigation confirmed that the coating on the cutting wire was torn and the cutting wire was broken.The cut marks were confirmed on the distal end of the cutting wire as information provided.The broken section on the handle side of the cutting wire was melted and burned.Approximately coating was missing for 5.0 mm from the broken point.There were no other abnormalities related to the breakage in the subject device.Also as the checking of the manufacturing record of the same lot, nothing abnormal was detected for the following items.A.The length of the pfa wire.B.The appearance of the pfa wire.C.The movement of the cutting wire.D.The general appearance.This type of damage is most likely related to the operator's technique.As the results of the investigation, omsc assumes that the damage of the coating and cutting wire occurred due to contacting with the metal part of the forceps elevator of the endoscope.The exposed cutting wire from the damaged coating contacted or came close to the metal part of the forceps elevator while activating the output, which caused spark and a part of the cutting wire became extremely hot, resulting in breakage.The coating broke off and came off from the cutting wire because of the user handling after the cutting wire was broken.The device instruction manual has warned users that "when inserting the instrument into the endoscope, be sure that the cutting wire is parallel to the tube.

Event Description

During an ercp, a small incision was made on the papilla.The cutting wire broke when the output was activated to make another incision.The physician removed the subject device from the endoscope and cut the distal end of the broken cutting wire with a tool.The physician inserted the subject device into the endoscope again and continued the procedure by dilating the papilla using the balloon of the subject device.The physician completed the intended procedure.There was no patient injury reported.The subject product was returned to omsc for investigation on oct.4, 2016.The investigation confirmed that the cutting wire was broken.The coating on the cutting wire was approximately missing for 5.0mm from the broken point.

• Brand Name: SINGLE USE BALLOON DILATOR V (WITH KNIFE)
• Type of Device: SINGLE USE BALLOON DILATOR V (WITH KNIFE)
• Manufacturer (Section D): OLYMPUS MEDICAL SYSTEMS CORP.; 2951; ishikawa-cho; hachioji-shi, tokyo 192-8 507; JA 192-8507
• Manufacturer Contact: susumu nishina ; 2951; ishikawa-cho; hachioji-shi, tokyo 192-8-507 ; JA 192-8507 ; 42 6425117
• MDR Report Key: 6028860
• MDR Text Key: 57440006
• Report Number: 8010047-2016-01349
• Device Sequence Number: 1
• Product Code: KNS
• Combination Product (y/n): N
• Reporter Country Code: JA
• PMA/PMN Number: K150142
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: health professional,user faci
• Reporter Occupation: Other
• Type of Report: Initial
• Report Date: 10/14/2016

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 10/13/2016
• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Device Operator: Physician
• Device Model Number: BD-VC431Q-1840-20
• Device Lot Number: 67K
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 10/03/2016
• Date Manufacturer Received: 10/04/2016
• Was Device Evaluated by Manufacturer?: Yes
• Is the Device Single Use?: Yes
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: Initial
• Patient Sequence Number: 1