MAUDE MDR 7912563

MDR report key
7912563
Report number
2951238-2018-00576
Event key
0
Event type
3
Date of event
2018-06-11
Date received
2018-09-26
Adverse event
3
Product problem
3
Patients in event
0
Reporter occupation
1
Health professional
3
Initial report to FDA
3
Event location
3

Manufacturer Contact#

Contact
MS. CONNIE TUBERA
Address
2400 RINGWOOD AVENUE SAN JOSE CA 95131 US
Phone
408-408-4089
Report source
M
Manufacturer link flag
Y

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1UROPASS AS 11/13FR X 38 CM 5/BXUROPASS ACCESS SHEATHTELEFLEX MEDICAL OEMKNY61138BX61138BX09L1700121R N

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12018-09-2601. H; 2. R

Event Narratives#

N

Patient 1

THE ACCESS SHEATHS WILL NOT BE RETURNED TO OLYMPUS FOR EVALUATION AS THE USER FACILITY DISCARDED THEM FOLLOWING THE PROCEDURE. THE CAUSE OF THE REPORTED EVENT CANNOT BE CONFIRMED. HOWEVER, BASED ON THE REPORTED INFORMATION, THE OPERATOR?S TECHNIQUE CANNOT BE RULED OUT AS A CONTRIBUTORY FACTOR OF THE REPORTED EVENT. THE REPORTED EVENT IS LISTED AS A POTENTIAL COMPLICATION THAT CAN OCCUR DURING OPERATION. THE INSTRUCTION MANUAL (SECTION 3.0) STATES, ?PATIENTS OR THEIR REPRESENTATIVES SHOULD BE INFORMED OF THE POSSIBLE COMPLICATIONS ASSOCIATED WITH THE USE OF THIS PRODUCT. GYRUS ACMI REQUESTS THAT PHYSICIANS NOTIFY THE COMPANY OF COMPLICATIONS THAT MAY OCCUR WITH THE USE OF THIS DEVICE. COMPLICATIONS MAY INCLUDE BUT ARE NOT LIMITED TO MUCOSAL IRRITATION, INFLAMMATION AND PERFORATION OF THE URETHRA, BLADDER, OR URETER.? IN ADDITION, DO NOT APPLY EXCESSIVE FORCE TO THE PRODUCT OR USE IT EXCESSIVELY. IT IS LIKELY TO INJURE OR CAUSE PERFORATION IN THE URINARY TRACT OF THE PATIENT. THE INSTRUCTION MANUAL STATES, ?ADVANCE THE DILATOR/SHEATH ASSEMBLY OVER THE GUIDEWIRE TO THE DESIRED LOCATION. IF RESISTANCE IS ENCOUNTERED, STOP! DO NOT ADVANCE AGAINST RESISTANCE. DAMAGE TO THE ANATOMY COULD RESULT.?

D

Patient 1

OLYMPUS WAS INFORMED THAT ON JUNE 12, 2018 AN OLYMPUS URF-V2 WAS INSERTED INTO THE RENAL PELVIC USING A NON-OLYMPUS RIGID CYSTOSCOPE, NON-OLYMPUS GUIDE WIRE, AND AN OLYMPUS ACCESS SHEATH, 61138BX. THE PHYSICIAN DETERMINED THAT AN ACCESS SHEATH OF A THINNER DIAMETER WAS REQUIRED; THE PHYSICIAN CHANGED TO A 61046BX AND THE RENAL PELVIC BIOPSY PROCEDURE WAS COMPLETED WITHOUT ISSUE. FOLLOWING THE RENAL PELVIC BIOPSY PROCEDURE, A NON-OLYMPUS STENT WAS PLACED IN THE PATIENT?S URETER USING A NON-OLYMPUS RIGID CYSTOSCOPE AND GUIDE WIRE. AFTER SOME TIME ATTEMPTING TO PASS THE GUIDE WIRE THROUGH THE URETERAL OPENING, ANOTHER DOCTOR PASSED THE GUIDE WIRE AND PLACED THE URETERAL STENT. NO OLYMPUS ACCESS SHEATH WAS USED FOR THE PROCEDURE OF INDWELLING THE STENT. THERE WERE NO MALFUNCTIONS NOTED ON THE CONCERNED EQUIPMENT. ON (B)(6) 2018, THE STENT WAS REMOVED FROM THE PATIENT. ON (B)(6) 2018, THE PATIENT VISITED THE OUTPATIENT CLINIC DUE TO A FEVER. DURING THE VISIT THEY FOUND URETERAL DAMAGE AS A URINARY CYST HAD FORMED. ON (B)(6) 2018, THE STENT WAS PLACED BACK IN THE URETER. ON (B)(6) 2018, THE URINARY CYST WAS PUNCTURED AND DRAINED UNDER A CT GUIDE. ON (B)(6) 2018 THE STENT WAS REMOVED FROM THE PATIENT AND THE PATIENT WAS DISCHARGED FROM THE HOSPITAL. ONE OF 2 DEVICES.