MAUDE MDR 7504010

MDR report key
7504010
Report number
1528319-2018-00015
Event key
0
Event type
3
Date of event
2018-03-12
Date received
2018-05-10
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
MRS. COLETTA COHARA
Address
5976 HEISLEY RD MENTOR OH 44060 US
Phone
440-440-4403
Report source
M
Manufacturer link flag
Y

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1EXACTO COLD SNARECOLD SNAREUNITED STATES ENDOSCOPY GROUP, INC.FGX00711115007111151711589Y Y

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12018-05-100

Event Narratives#

N

Patient 1

THE EXACTO COLD SNARE IS INTENDED TO BE USED WITHOUT DIATHERMIC ENERGY FOR THE ENDOSCOPIC RESECTION OF POLYP TISSUE IN THE GASTROINTESTINAL TRACT. THE REPORT INDICATES THAT THE DOCTOR WAS UNABLE TO FULLY RETRACT THE SNARE, RESULTING IN FAILURE TO COMPLETELY RESECT A POLYP. THE TISSUE WAS INSTEAD PULLED TO FREE THE POLYP, WITH A RESULTANT SMALL BLEED. THE BLEED WAS DESCRIBED AS "SMALL". HOWEVER, CAUTERY WAS APPLIED TO THE BLEED SITE. THE SUBJECT DEVICE WAS RETURNED TO USE. THE DEVICE WAS EVALUATED AND FOUND TO BE INTACT AND FUNCTIONAL, WITH NO EVIDENCE OF DAMAGE TO THE SHEATH. THE DEVICE HISTORY RECORD WAS REVIEWED AND CONFIRMED THE DEVICE WAS MANUFACTURED TO SPECIFICATION. NO OTHER COMPLAINTS OF ANY TYPE ARE ASSOCIATED WITH EXACTO COLD SNARE UNITS FROM THE LOT (00711115 LOT 1711589). THE FOLLOWING STATEMENTS ARE INCLUDED IN THE INSTRUCTIONS FOR USE: "DISENGAGE THE SNARE FROM THE POLYP IF THERE IS A RISK OF COMPLICATION. THE FOLLOWING CONDITIONS MAY NOT ALLOW THE DEVICE TO FUNCTION PROPERLY OR CAUSE PATIENT INJURY: ATTEMPTING TO ADVANCE THE HANDLE TO THE OPEN POSITION WITH TOO MUCH SPEED OR FORCE, ATTEMPTING TO PASS OR OPEN THE DEVICE IN AN EXTREMELY ARTICULATED ENDOSCOPE, ATTEMPTING TO ACTUATE THE DEVICE IN AN EXTREMELY COILED POSITION AND/OR, ATTEMPTING TO ACTUATE THE DEVICE WHEN THE HANDLE IS AT AN ACUTE ANGLE IN RELATION TO THE SHEATH. PRIOR TO CLINICAL USE, INSPECT AND FAMILIARIZE YOURSELF WITH THE DEVICE. IF THERE IS EVIDENCE OF DAMAGE, DO NOT USE THIS PRODUCT AND CONTACT YOUR LOCAL PRODUCT SPECIALIST. INSERT THE DEVICE INTO THE BIOPSY PORT OF THE ENDOSCOPE USING SHORT STROKES, APPROXIMATELY 1"-1.5" (2.5CM - 3.8CM) IN LENGTH THROUGHOUT DEVICE PASSAGE TO AVOID SHEATH KINKING." RESPONSE IS PENDING ON THE OFFER OF IN-SERVICE.

D

Patient 1

THE USER FACILITY REPORTED THE EXACTO COLD SNARE SHEATH BECAME BUCKLED AND THE DEVICE FAILED TO COMPLETELY RESECT A POLYP. THE TISSUE WAS INSTEAD PULLED TO FREE THE POLYP, WITH A RESULTANT SMALL BLEED. CAUTERY WAS APPLIED AT THE SITE OF THE BLEED.