MAUDE Adverse Event Report: PENUMBRA, INC. RUBY COIL; HCG, KRD

Catalog Number	RBY4C0201
Medical Device Problem Codes	Failure to Advance (2524); Physical Resistance (2578); Mechanical Jam (2983)
Health Effect - Clinical Code	No Consequences Or Impact To Patient (2199)
Date of Event	02/13/2017
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
The product was not returned for evaluation.Without the return of the device, the root cause of the problem cannot be determined.The manufacturing records for this lot were reviewed and did not reveal any outstanding discrepancies, design, or quality concerns.This report is associated with mfr report numbers: 3005168196-2017-00385; 3005168196-2017-00386.The hospital disposed of the device.
Event or Problem Description
The patient was undergoing a coil embolization procedure on (b)(6) 2017 using ruby coils.During the procedure, while advancing a ruby coil through a non-penumbra microcatheter, the physician experienced resistance and the ruby coil became stuck and unable to advance.Although the physician experienced resistance while retracting it, the ruby coil was successfully removed.The procedure was then halted for reasons not related to any penumbra product.There was no report of an adverse effect to the patient.The physician then reattempted the coil embolization procedure on (b)(6) 2017 using ruby coils.During the procedure, while advancing a ruby coil through a non-penumbra microcatheter, the physician experienced resistance and the ruby coil was unable to advance out of the microcatheter; therefore,it was removed.This same issue occurred again with a new ruby coil, and then the procedure was completed using another new ruby coil and the same non-penumbra microcatheter.There was no report of an adverse effect to the patient.The physician then reattempted the coil embolization procedure on (b)(6) 2017 using ruby coils.During the procedure, while advancing a ruby coil through a non-penumbra microcatheter, the physician experienced resistance and the ruby coil was unable to advance out of the microcatheter; therefore,it was removed.This same issue occurred again with a new ruby coil, and then the procedure was completed using another new ruby coil and the same non-penumbra microcatheter.It was reported that the physician did not use an rhv and did not maintain continuous flush.There was no report of an adverse effect to the patient.

• Brand Name: RUBY COIL
• Common Device Name: HCG, KRD
• Manufacturer (Section D): PENUMBRA, INC.; one penumbra place; alameda CA 94502
• MDR Report Key: 6408227
• Report Number: 3005168196-2017-00384
• Device Sequence Number: 798249
• Product Code: HCG
• UDI-Device Identifier: 00814548013114
• UDI-Public: 00814548013114
• Combination Product (Y/N): N
• Initial Reporter State: AL
• Initial Reporter Country: US
• PMA/510(K) Number: K120330
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: company representative,health
• Initial Reporter Occupation: Physician
• Type of Report: Initial
• Report Date (Section B): 02/15/2017

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: Physician
• Device Expiration Date: 09/17/2024
• Device Catalogue Number: RBY4C0201
• Device Lot Number: F71620
• Was Device Available for Evaluation?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 02/15/2017
• Initial Report FDA Received Date: 03/15/2017
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1
• Patient Age: 80 YR
• Patient Weight: 59