MAUDE Adverse Event Report: BOSTON SCIENTIFIC CORPORATION SUPER SHEATH INTRODUCER SHEATH; INTRODUCER, CATHETER

Model Number	28182
Medical Device Problem Code	Device Contamination with Chemical or Other Material (2944)
Health Effect - Clinical Code	No Consequences Or Impact To Patient (2199)
Date of Event	04/01/2020
Type of Reportable Event	Malfunction
Event or Problem Description
It was reported that there was moisture in the packaging.The 5 fr x 11 cm super sheath introducer sheath was selected for use.During preparation, moisture was noted in the internal packaging and there was concern regarding the sterility of the sheath.A new super sheath introducer sheath with a different batch number was used to complete the procedure.No patient was involved at the time of the event.
Event or Problem Description
It was reported that there was moisture in the packaging.The 5 fr x 11 cm super sheath introducer sheath was selected for use.During preparation, moisture was noted in the internal packaging and there was concern regarding the sterility of the sheath.A new super sheath introducer sheath with a different batch number was used to complete the procedure.No patient was involved at the time of the event.
Additional Manufacturer Narrative
Device evaluated by manufacturer: the product was returned inside the sealed sterile pouch.Visual examination confirmed moisture was adhered to the inside of the sterile pouch.Further examination confirmed that the moisture was silicone oil.Silicone oil was also observed surrounding the hemostatic valve.Silicone oil is used during the manufacturing process and applied to the hemostatic valve.The oil facilitates smooth operation of the valve during use.Silicone oil is not used anywhere else during the manufacturing process.The amount of silicone oil applied to the hemostatic valve is minimal, but not constant.If manufacturing personnel determines that excess silicone oil has been applied during the set-up of the sheath and dilator, or if silicone oil deposits are observed in areas that come into contact with the sterilization bag before the product is placed in the sterilization bag, the manufacturing procedure requires to wipe off the silicone oil deposits.In addition, final visual inspection of foreign material is conducted at the package to shelf carton.It is thought that the silicone oil applied to the sheath valve came into contact with the inner sterile pouch due to vibration during transportation and storage condition.

• Brand Name: SUPER SHEATH INTRODUCER SHEATH
• Common Device Name: INTRODUCER, CATHETER
• Manufacturer (Section D): BOSTON SCIENTIFIC CORPORATION; two scimed place; maple grove MN 55311
• MDR Report Key: 9929154
• Report Number: 2134265-2020-04388
• Device Sequence Number: 690462
• Product Code: DYB
• UDI-Device Identifier: 14543527181638
• UDI-Public: 14543527181638
• Combination Product (Y/N): N
• Initial Reporter State: NH
• Initial Reporter Country: US
• 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): 05/20/2020

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 Expiration Date: 09/30/2022
• Device Model Number: 28182
• Device Catalogue Number: 28182
• Device Lot Number: 19J07BA
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 04/21/2020
• Initial Date Received by Manufacturer: 04/01/2020
• Supplement Date Received by Manufacturer: 05/11/2020
• Initial Report FDA Received Date: 04/06/2020
• Supplement Report FDA Received Date: 05/20/2020
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1