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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: AV-TEMECULA-CT NC TREK CORONARY DILATATION CATHETER

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AV-TEMECULA-CT NC TREK CORONARY DILATATION CATHETER Back to Search Results
Catalog Number 1012449-12
Device Problems Detachment Of Device Component (1104); Failure to Advance (2524)
Patient Problem No Consequences Or Impact To Patient (2199)
Event Date 12/01/2016
Event Type  malfunction  
Manufacturer Narrative
(b)(4). During processing of this complaint, attempts were made to obtain complete event, patient and device information. The device is expected to be returned for evaluation. It has not yet been received. A follow up report will be submitted with all relevant information.
 
Event Description
It was reported that the procedure was to treat a lesion located in the mid left anterior descending (lad) artery with heavy tortuosity and mild calcification. Resistance was felt during advancement of the 3. 0 mm x 12 mm nc trek rx balloon dilatation catheter (bdc) to the lesion and the hypotube of the bdc separated prior to crossing the lesion. A replacement bdc was used to complete the procedure. There were no adverse patient effects or clinically significant delay the procedure reported. No additional information was provided.
 
Manufacturer Narrative
(b)(4). It was initially reported that the device would be returned for analysis; however the device was not returned. The device was not returned for evaluation. A review of the lot history record identified no manufacturing nonconformities issued to the reported lot that would have contributed to this event. Additionally, a review of the complaint history of the reported lot did not indicate a lot specific quality issue. The investigation determined the reported difficulties appear to be related to circumstances of the procedure. There is no indication of a product quality issue with respects to the design, manufacture, or labeling of the device.
 
Manufacturer Narrative
(b)(4). It was reported that the device was not returned for analysis; however, the device was returned. Evaluation summary: visual and dimensional inspections were performed on the returned device. The proximal shaft separation was confirmed. The failure to advance could not be replicated in a testing environment as it was based on operational circumstances. The investigation determined the reported failure to advance and proximal shaft separation appear to be related to circumstances of the procedure since the device interacted with the difficult anatomy. There is no indication of a product quality issue with respects to the design, manufacture, or labeling of the device.
 
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Brand NameNC TREK CORONARY DILATATION CATHETER
Type of DeviceCORONARY DILATATION CATHETER
Manufacturer (Section D)
AV-TEMECULA-CT
abbott vascular
26531 ynez road
temecula CA 92591 4628
Manufacturer (Section G)
EL COYOL, COSTA RICA REG# 3009031392
abbott vascular
26531 ynez road
temecula CA 92591 4628
Manufacturer Contact
connie speck
abbott vascular
26531 ynez road
temecula, CA 92591-4628
9519143996
MDR Report Key6193049
MDR Text Key63325878
Report Number2024168-2016-09094
Device Sequence Number1
Product Code LOX
Combination Product (y/n)N
Reporter Country CodeCH
PMA/PMN Number
K110134
Number of Events Reported1
Summary Report (Y/N)N
Report Source Manufacturer
Source Type company representative,distri
Reporter Occupation
Remedial Action Other
Type of Report Initial,Followup,Followup
Report Date 04/25/2017
1 Device was Involved in the Event
0 Patients were Involved in the Event:
Date FDA Received12/21/2016
Is this an Adverse Event Report? No
Is this a Product Problem Report? Yes
Device Operator
Device Expiration Date04/30/2019
Device Catalogue Number1012449-12
Device Lot Number60511G1
Was Device Available for Evaluation? Device Returned to Manufacturer
Date Returned to Manufacturer03/21/2017
Is the Reporter a Health Professional? Yes
Was the Report Sent to FDA?
Event Location No Information
Date Manufacturer Received04/17/2017
Was Device Evaluated by Manufacturer? Yes
Date Device Manufactured05/01/2016
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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