MAUDE MDR 8634945

MDR report key
8634945
Report number
3003902943-2019-00017
Event key
0
Event type
3
Date of event
2019-04-23
Date received
2019-05-23
Adverse event
3
Product problem
3
Patients in event
0
Reporter occupation
3
Health professional
3
Initial report to FDA
3
Event location
3

Manufacturer Contact#

Contact
MR. LEE
Address
14, GOJEONG-RO WOLGOT-MYEON GIMPO-SI, 10022 KS
Report source
M
Manufacturer link flag
Y

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1NITI-S PYLORIC & DUODENAL UNCOVERED STENTPYLORIC & DUODENAL STENTTAEWOONG MEDICAL CO.,LTD.MUMDXDT2210R N

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12019-05-230

Event Narratives#

N

Patient 1

IT WAS REPORTED THAT, APPROXIMATELY 4 MONTHS AFTER STENT DEPLOYMENT, BY SEEING THE X-RAY, THE STENT WAS FOUND TO BE FRACTURED IN THE PART STICKING OUT. IT WAS CONFIRMED FROM THE DEVICE HISTORY RECORD THAT DEVICE HAD BEEN MANUFACTURED WITH NO SIGNIFICANT ISSUE AND PASSED ALL THE INSPECTIONS SUCCESSFULLY. FRACTURE CAN BE OCCURRED BY OTHER COMPANY'S DEVICE AS WELL AS OURS. IT IS AFFECTED BY PATIENT'S LESION STATUS, PERISTALSIS OF ORGANS, AND DRUG USE IN GENERAL. DUODENUM STRUCTURE WHERE STENT WAS IMPLANTED IS CURVY. STENT CAN BE FREQUENTLY PRESSURED DUE TO PATIENT'S LESION STATUS, AND FRACTURE BE POSSIBLE. HOWEVER, IT IS HARD TO IDENTIFY THE EXACT ROOT CAUSE SINCE IT IS HARD TO RECONSTRUCT THE SITUATION AT THE TIME OF PROCEDURE, THE STENT WAS NOT RETURNED, AND THE LACK OF INFORMATION SUCH AS THE SUSPECT DEVICE'S PHOTO. BASED ON THE DESCRIPTION, WHICH WAS WRITTEN THAT "DXDT2210 WAS PLACED WITH 2CM OF ITS PROXIMAL SIDE STICKING OUT OF PYLORUS INTO THE STOMACH, AND THE STENT WAS FOUND TO BE FRACTURED IN THE PART STICKING OUT", IT IS ASSUMED THAT THE WIRE WAS SOMEWHAT WEAKENED DUE TO THE PATIENT LESION'S PERISTALSES AND PRESSURE AND FOREIGN SUBSTANCE SUCH AS FOODS, BODY FLUIDS AND SO ON, RESULTED IN STENT FRACTURE. IT IS STATED ON USER MANUAL AS FOLLOWS. POTENTIAL COMPLICATIONS: POTENTIAL COMPLICATIONS ASSOCIATED WITH THE USE OF NITI-S & COMVI STENT MAY INCLUDE, BUT ARE NOT LIMITED TO: STENT FRACTURE. THIS SUSPECTED DEVICE IS NOT REGISTERED IN THE US BUT WE WILL CONTINUOUSLY MONITOR THE SAME OR SIMILAR CUSTOMER COMPLAINTS THROUGH ACCURATE ANALYSES.

D

Patient 1

ON (B)(6) 2018: DXDT2210 WAS PLACED WITH 2CM OF ITS PROXIMAL SIDE STICKING OUT OF PYLORUS INTO THE STOMACH. ON (B)(6) 2019: BY SEEING THE X-RAY, THE STENT WAS FOUND TO BE FRACTURED IN THE PART STICKING OUT. THE WIRE OF THE FRACTURED STENT WAS BROKEN IN PIECES AND REMAINED IN PYLORIC RING AND REMAINING PART OF THE STENT. ON (B)(6) 2019: THE BROKEN WIRE WAS REMOVED OUT OF THE PATIENT'S BODY. THE REMAINING STENT WAS STILL PATENT, AND NO ADDITIONAL STENT WAS PLACED. THERE WERE NO PATIENT COMPLICATIONS AS A RESULT OF THIS EVENT.