N
Patient 1
NO PRODUCT IS BEING RETURNED FOR EVALUATION AND NO LOT # HAS BEEN PROVIDED TO MANUFACTURER. A FOLLOW UP REPORT WILL BE SENT ONCE THE RESULTS HAVE BEEN ANALYZED.
MAUDE MDR 6691880
- MDR report key
- 6691880
- Report number
- 2027111-2017-01883
- Event key
- 0
- Event type
- 3
- Date received
- 2017-07-06
- Adverse event
- 3
- Product problem
- 3
- Patients in event
- 0
- Reporter occupation
- 0
- Health professional
- 3
- Initial report to FDA
- 3
- Event location
- 3
Manufacturer Contact#
- Contact
- WENDY KOBAYASHI
- Address
- 22872 AVENIDA EMPRESA RANCHO SANTA MARGARITA CA 92688 US
- Phone
- 949-949-9497
- Report source
- M
- Manufacturer link flag
- Y
Devices#
| Seq | Brand | Generic | Manufacturer | Product code | Model | Catalog | Lot | PMA | 510(k) | Implant | Evaluated | Availability |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 | C8322, XS ALEXIS WND PROT/RET SHRT 5/BX | KGW | APPLIED MEDICAL RESOURCES | KGW | 4 | 4 | UNK | R | N |
Patients#
| Sequence | Received | Treatment | Outcome |
|---|---|---|---|
| 1 | 2017-07-06 | 0 |
Event Narratives#
D
Patient 1
PROCEDURE PERFORMED: VATS. EVENT DESCRIPTION: ALEXIS TEARING AT (B)(6) IN CARDIO THORACIC CASES. THEY HAVE HAD 7 ALEXIS TEARS IN THESE CASES. [SURGEON] COMMUNICATED THE FOLLOWING REGARDING THE DEVICE ALONG WITH SUGGESTIONS: -THE DEVICE IS TEARING DURING INSERTION AND REMOVAL, AND NOT ALL THE TIME. -THE DEVICE PLACEMENT IS THE SAME AND THIS IS OCCURRING DURING VAT PROCEDURES. -HE IS ROLLING THE DEVICE OUTWARD AS INDICATED. -HE ADMITTED THE TEARING OF THE PLASTIC SHEATH IS OFTEN CAUSED BY POKING IT WITH AN OBJECT (EVEN HIS OWN FINGER). ONE DEVICE IS RETURNING ON CER (2017-1091). THE OTHER CERS HAVE NO PRODUCT RETURNING (2017-1100/1101/1102/1103/1104/1105). ADDITIONAL INFORMATION RECEIVED VIA TELEPHONE FROM [APPLIED MEDICAL TEAM MEMBER #1] ON JUNE 19, 2017 - IT IS UNSURE IF THE ALEXIS MODEL USED WAS THE C8312 OR THE C8322, BUT IT IS BELIEVED TO BE THE REGULAR XS ALEXIS (C8312). THE OTHER PRODUCTS FROM THE OTHER CASES ARE NOT AVAILABLE AS THEY WERE DISPOSED. ADDITIONAL INFO RECEIVED VIA TELEPHONE FROM [APPLIED MEDICAL TEAM MEMBER #1] AND [APPLIED MEDICAL TEAM MEMBER #2] ON JUNE 26, 2017 - IT WAS CONFIRMED THE PRODUCT FOR THIS CER WAS THE XX SMALL ALEXIS (C8323). THE REST OF THE EVENTS HAVE BEEN USED WITH THE XS SHORT ALEXIS (C8322). IT WAS MENTIONED THAT THE TEARS OCCUR DURING REMOVAL OF THE FLEXIBLE RING. THE SURGEON EXPLAINED IT IS DIFFICULT TO GET HIS FINGER AROUND THE RING TO PULL IT OUT AND IS TEARING AS A RESULT. IT IS TEARING INTRAABDOMINALLY WITHIN THE INTERCOSTAL AREA ABOVE THE FLEXIBLE RING. ACCORDING TO THE DOCTOR, THE REASON THE DEVICE IS BEING ROLLED OUTWARD INSTEAD OF INWARD BECAUSE THIS GIVES THE SURGEON EXTRA SPACE WHEN REMOVING.