MAUDE Adverse Event Report: BARD PERIPHERAL VASCULAR, INC. SENOMARK BIOPSY SITE MARKERS; BIOPSY INSTRUMENT

Model Number	SMEC10GSS
Medical Device Problem Codes	Positioning Failure (1158); Difficult to Remove (1528); Failure to Advance (2524)
Health Effect - Clinical Code	No Consequences Or Impact To Patient (2199)
Date of Event	05/10/2018
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
As the lot number for the device was provided, a manufacturing review will be performed.The sample was not returned to the manufacturer for inspection/evaluation.Therefore, the investigation of the reported event is inconclusive.Based upon the available information, the definitive root cause for this event is unknown.The instructions for use (ifu) is adequate for the reported device/patient code(s) and provides general instructions for use, as well as warnings, precautions and potential complications associated with the device.Upon receipt of new or additional information, a follow-up report will be submitted as applicable.(b)(4).The information provided by bard represents all of the known information at this time.Despite good faith efforts to obtain additional information, the complainant / reporter was unable or unwilling to provide any further patient, product, or procedural details to bard.
Event or Problem Description
It was reported that during a mammographic-guided breast biopsy for a small cluster of calcifications, the marker allegedly failed to advance, failed to deploy, and afterwards failed to be removed from the probe.Reportedly, the patient was given more local anesthesia (lidocaine) and the probe and a portion of the marker were removed as one unit from the patient, while the cutter was open.Post procedure imaging indicated that a portion of the marker was allegedly sheared off by the cutter and now remains in the patient.There was no reported patient injury.

• Brand Name: SENOMARK BIOPSY SITE MARKERS
• Common Device Name: BIOPSY INSTRUMENT
• Manufacturer (Section D): BARD PERIPHERAL VASCULAR, INC.; 1625 w 3rd st.; tempe AZ 85281
• MDR Report Key: 7580884
• Report Number: 2020394-2018-00822
• Device Sequence Number: 1523878
• Product Code: NEU
• UDI-Device Identifier: 00801741031915
• UDI-Public: (01)00801741031915
• Combination Product (Y/N): N
• Initial Reporter Country: CA
• PMA/510(K) Number: K050090
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: company representative,foreig
• Initial Reporter Occupation: Nurse
• Type of Report: Initial
• Report Date (Section B): 06/07/2018

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: SMEC10GSS
• Device Catalogue Number: SMEC10GSS
• Device Lot Number: VTBX00459
• Was Device Available for Evaluation?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 05/14/2018
• Initial Report FDA Received Date: 06/07/2018
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1