MAUDE Adverse Event Report: COOK INC ADVANCE 35 LP LOW PROFILE BALLOON CATHETER; DQY CATHETER, PERCUTANEOUS

Model Number	G52260
Medical Device Problem Code	Material Rupture (1546)
Health Effect - Clinical Code	No Known Impact Or Consequence To Patient (2692)
Date of Event	10/20/2017
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
(b)(4).The event is currently under investigation.A supplemental report will be provided upon conclusion.
Event or Problem Description
It was reported that during an sfa peripheral procedure, the advance 35 lp low profile balloon catheter ruptured circumferentially.The procedure was successfully completed using another cook device.The patient's artery was reported to be heavily calcified.A section of the device did not remain inside the patient¿s body.The patient did not require any additional procedures due to this occurrence.According to the initial reporter, the patient did not experience any adverse effects due to this occurrence.
Additional Manufacturer Narrative
Investigation - evaluation : a review of the complaint history, dimensional verification, device history record, documentation, instructions for use (ifu), manufacturing instructions, specifications, quality control, functional testing, and visual inspection of the returned device was conducted during the investigation.One used advance 35 lp low profile balloon catheter was returned for evaluation.Both marker bands are present.There was 1.5 centimeter (cm) of tubing between balloon segments.The catheter was measured and noted to be elongated.An abrasion was present.The balloon is ruptured radially and longitudinally.The proximal and distal sections of the balloon were measured to be within specifications.A document-based investigation was performed.There is no evidence to suggest the finished product was not made to specifications.Numerous design verification and validation activities have been performed to ensure that this device meets design requirements.Review of the device history record of the finished product shows no nonconforming events that could contribute to this failure mode.A complaint history search revealed that there were no other reported complaints for this lot number.Per the ifu," the balloon is manufactured from an extra-thinwall, high-strength, minimally-complaint material.Particular care should be taken in handling the balloon to prevent damage.Do not exceed rated burst pressure.Rupture of balloon may occur.Over-inflation may cause rupture of the balloon, with resultant damage to the vessel wall.The burst pressure data was analyzed using factors for a one-sided tolerance to determine with a 95% confidence that 99.9% of these balloons would not burst at or below the calculated rated burst pressure.In heavily scarred access site, use of an introducer sheath is recommended.Use only the recommended balloon inflation medium.Choose a balloon appropriate to lesion length and vessel diameter.Upon removal from package, inspect the product to ensure no damage has occurred." based on the information provided, examination of the returned product, and the results of our investigation, a definite root cause could not be determined; however, it is possible that this event occurred due to patient condition as heavy calcification was noted.Appropriate measures have been initiated to address this failure mode.A quality engineering risk assessment was conducted; the appropriate personnel have been notified and monitoring will continue to be performed for similar complaints.

• Brand Name: ADVANCE 35 LP LOW PROFILE BALLOON CATHETER
• Common Device Name: DQY CATHETER, PERCUTANEOUS
• Manufacturer (Section D): COOK INC; 750 daniels way; bloomington IN 47404
• MDR Report Key: 6982304
• Report Number: 1820334-2017-03732
• Device Sequence Number: 118911
• Product Code: DQY
• UDI-Device Identifier: 10827002522609
• UDI-Public: (01)10827002522609(17)200117(10)7597277
• Combination Product (Y/N): N
• Initial Reporter State: IL
• Initial Reporter Country: US
• PMA/510(K) Number: K091527
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: company representative,health
• Initial Reporter Occupation: Other Health Care Professional
• Type of Report: Initial,Followup
• Report Date (Section B): 03/01/2018

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 Model Number: G52260
• Device Catalogue Number: PTA5-35-135-5-8.0
• Was Device Available for Evaluation?: Yes
• Initial Date Received by Manufacturer: 10/24/2017
• Supplement Date Received by Manufacturer: 02/16/2018
• Initial Report FDA Received Date: 10/26/2017
• Supplement Report FDA Received Date: 03/01/2018
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1