MAUDE Adverse Event Report: MEDOS INTERNATIONAL SARL DELTAPAQ - CERECYTE MICROCOIL; NEUROVASCULAR EMBOLIZATION DEVICE

Catalog Number	CDF10020330
Medical Device Problem Code	Positioning Failure (1158)
Health Effect - Clinical Code	No Consequences Or Impact To Patient (2199)
Date of Event	11/21/2016
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
This is one of one initial mdr reports being submitted for this complaint with associated mfr# 2954740-2016-00311.(b)(4).The product is expected to be returned for analysis, however it has not been received.Additional information will be submitted within 30 days of receipt.No conclusions are made at this time.
Event or Problem Description
As reported by a healthcare professional, during coil embolization procedure the deltapaq 2mm x 3 cm (cdf10020330/c30399) coil failed to detach.The coil was withdrawn and a new coil was used to complete the procedure.The coil was still attached to the delivery system when removed from the patient.There were no damages noted to the coil/coil delivery system/detachment system prior to use or after removal.A pre-deployment electrical check was performed and the green system ready light illuminated; during the detachment cycle the detachment light did not illuminate.All connections appeared to fit properly without application of excessive force.The same connecting cable and dcb were used successfully with subsequent coils.There was no report on the patient injury.There were no intra or post procedural complications or delays related to the device or reported event.The patient information is unknown.It was initially reported that the complaint product is available for return.
Additional Manufacturer Narrative
This is one of one final mdr reports being submitted for this complaint with associated mfr# 2954740-2016-00311.Limited information was received.The unidentified detachment control box (dcb) and the connecting cable were not returned.The unidentified microcatheter was not returned.Concerning cleanliness only, the microcoil system was returned in almost pristine condition.The system was either not used or was cleaned before being returned which may have produced further damage.It is also unknown if the device was improperly handled for returned packaging or was further manipulated and/or inspected post-procedurally.In addition, any trace or other evidence that may have been complaint related may have been altered or removed prior to being returned due to post-procedural handling, cleaning, and packaging.All location and measurement callouts are approximate and for reference only.The coil was returned undamaged.The detachment fiber did not receive heat and melt.The device positioning unit (dpu) passed electrical testing with resistance at 51.8 ohms (range 48.5/56.0) (b)(4) and the test enpower and cable systems ready green light illuminated (deltapaq ifu).The coil detached on the first detachment cycle.Post-detachment inspection found that the enpower systems ready green light remained illuminated and the resistance passed at 51.9 ohms.The field complaint of the coils non-detachment or the detachment light not illuminating could not be duplicated.Post-detachment inspection found that the detachment fiber received heat and melted as designed.No manufacturing defects were found.The complaint of the coils non-detachment and the detachment light not illuminating cannot be confirmed.The dpu passed electrical testing and the coil was detached on the first detachment cycle with the detachment light illuminating, therefore the root cause of the coils non-detachment and the failure of the detachment light to illuminate cannot be determined.In addition, without the return of the complete detachment system and the unidentified microcatheter used in the procedure, it cannot be determined if these components contributed to the complaint event.A review of the manufacturing documentation associated with this lot (c30399) presented no issues during the manufacturing or inspection process that can be related to the reported complaint.Based on the information and analysis, the event was not confirmed.The returned product passed testing and a review of the manufacturing documentation associated with this lot presented no issues during the manufacturing or inspection process that can be related to the reported complaint.Therefore, no corrective actions will be taken at this time.

• Brand Name: DELTAPAQ - CERECYTE MICROCOIL
• Common Device Name: NEUROVASCULAR EMBOLIZATION DEVICE
• Manufacturer (Section D): MEDOS INTERNATIONAL SARL; chemin-blanc 38; le locle neuchatel ; SZ
• MDR Report Key: 6173327
• Report Number: 2954740-2016-00311
• Device Sequence Number: 899874
• Product Code: HCG
• UDI-Device Identifier: 00878528007074
• UDI-Public: (01)00878528007074(17)191031(10)C30399
• Combination Product (Y/N): N
• Initial Reporter Country: CH
• PMA/510(K) Number: K080437
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: company representative,foreig
• Initial Reporter Occupation: Health Professional
• Type of Report: Initial,Followup
• Report Date (Section B): 11/23/2016

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: 10/31/2019
• Device Catalogue Number: CDF10020330
• Device Lot Number: C30399
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 12/21/2016
• Type of Report(Section G): FDA Requested
• Initial Date Received by Manufacturer: 11/23/2016
• Supplement Date Received by Manufacturer: Not provided
• Initial Report FDA Received Date: 12/14/2016
• Supplement Report FDA Received Date: 01/12/2017
• Patient Sequence Number: 1