MAUDE Adverse Event Report: GALIL MEDICAL LTD ICEROD PLUS 90° NEEDLE; CRYOABLATION NEEDLE, PRODUCT CODE

Model Number	FPRPR3508
Medical Device Problem Code	Device Operates Differently Than Expected (2913)
Health Effect - Clinical Code	No Consequences Or Impact To Patient (2199)
Date of Event	04/27/2018
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
The needle was returned for investigation.The manufacturing records were reviewed and no related deviation or concerns were found.The reported frost on the needle shaft was confirmed as the needle failed investigative testing.The needle was disassembled and inspected.No visible soldering gaps or voids were found.Microscopic inspection of the vacuum sleeve was conducted and no corrosive pits or soldering flux residuals were identified on the external surface of the vacuum sleeve.A bubble test of the vacuum sleeve was conducted; no leaks were identified.Based on the investigation results, the customer complaint was verified and the root cause was determined to be a component failure.No relationship was identified between the needle assembly processes and the vacuum loss phenomena.The treatment was completed with no injury to the patient as the physician used saline to protect the patient's skin.
Event or Problem Description
Prior to a cryoablation procedure, two icerod plus cryoablation needles and system tested fine with no issues to report.During the first freeze cycle the technician noticed the shaft of one of the needle started to collect frost.The patient's skin was covered with saline to prevent any injury.The procedure was completed as expected with no injury to the patient.

• Brand Name: ICEROD PLUS 90° NEEDLE
• Common Device Name: CRYOABLATION NEEDLE, PRODUCT CODE
• Manufacturer (Section D): GALIL MEDICAL LTD; 1 tavor building, p.o. box 224; industrial park; yokneam, israel 20692 03; IS 2069203
• MDR Report Key: 7551317
• Report Number: 9616793-2018-00036
• Device Sequence Number: 2018482
• Product Code: GEH
• UDI-Device Identifier: 07290104830563
• UDI-Public: 07290104830563
• Combination Product (Y/N): N
• Initial Reporter State: PA
• Initial Reporter Country: US
• PMA/510(K) Number: K110946
• 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): 05/29/2018

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: Physician
• Device Expiration Date: 04/23/2019
• Device Model Number: FPRPR3508
• Device Lot Number: B9924-037
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 05/22/2018
• Was the Report Sent to FDA?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 05/01/2018
• Initial Report FDA Received Date: 05/29/2018
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1