MAUDE Adverse Event Report: COOK IRELAND LTD ZIMMON BILIARY STENT; FGE CATHETER, BILIARY, DIAGNOSTIC

Model Number	G21711
Medical Device Problem Code	Kinked (1339)
Health Effect - Clinical Code	No Known Impact Or Consequence To Patient (2692)
Date of Event	01/27/2018
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
Cook ireland ltd (manufacturer) is submitting this report on behalf of cook medical incorporated (cmi)(importer).Exemption number: e2016031.Information pertaining to section g.1 as follows: importer site contact and address: (b)(4) cook medical incorporated (cmi) 1025 acuff road p.O box 4195 bloomington indiana 47402-4195.Importer site establishment registration number: 3005580113.1 x zso-7-15 device of lot #c1371427 was returned to cirl for evaluation.Upon evaluation of the returned device, a 0.035inch wire guide could not pass porthole 2 at the ductal end- confirmed kink.Indentation was noted at porthole 5 from the ductal end also.Side wall damage was noted in the second porthole from the ductal end, there was a bend on the main body of the stent.No other defects observed.A definitive root cause for the customer complaint could not be determined as the exact operational conditions of use could not be replicated in the laboratory setting.However it is possible that the stent became kinked while straightening the pigtails with the straightener.It may be noted that according to the instructions for use, ifu, the user is instructed to: ¿visually inspect with particular attention to kinks, bends and breaks.If any abnormality is detected that would prohibit proper working condition, do not use¿.As per the precautions section of the ifu; "care must be exercised when straightening the pigtails curls* in order to avoid kinking or breaking the stent." prior to distribution, all usi devices are subjected to 100% inspection to ensure device integrity.These inspections and functional checks are outlined in internal procedures in place at cirl.A review of the manufacturing records for the zso device of lot c1371427 did not reveal any discrepancy related to the complaint issue.There is no evidence to suggest that this issue affects the entire lot # c1371427; upon review of complaints this failure mode has not occurred previously with this lot # c1371427.This complaint is confirmed as the device was found to be kinked.Complaints of this nature will continue to be monitored for potential emerging trends.
Event or Problem Description
After removing stones to bile duct, physician tried to insert zso-7-15 to drain bile juice and sustain the duct, wire passed through the pigtail tip but stuck to the end of the pigtail part.The pigtail curved irregularly.(maybe broken).

• Brand Name: ZIMMON BILIARY STENT
• Common Device Name: FGE CATHETER, BILIARY, DIAGNOSTIC
• Manufacturer (Section D): COOK IRELAND LTD; o halloran road; limerick
• MDR Report Key: 7313107
• Report Number: 3001845648-2018-00105
• Device Sequence Number: 11197927
• Product Code: FGE
• UDI-Device Identifier: 00827002217119
• UDI-Public: (01)00827002217119(17)200623(10)C1371427
• Combination Product (Y/N): N
• Initial Reporter Country: KR
• PMA/510(K) Number: K851962
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: company representative,health
• Initial Reporter Occupation: Other
• Type of Report: Initial
• Report Date (Section B): 02/05/2018

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: G21711
• Device Catalogue Number: ZSO-7-15
• Was Device Available for Evaluation?: Yes
• Was the Report Sent to FDA?: No
• Distributor Facility Aware Date: 03/05/2018
• Event Location: Hospital
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 02/06/2018
• Initial Report FDA Received Date: 03/05/2018
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1