MAUDE MDR 9566256

MDR report key
9566256
Report number
2134265-2019-16528
Event key
0
Event type
3
Date of event
2019-11-15
Date received
2020-01-08
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
JAY JOHNSON
Address
TWO SCIMED PLACE MAPLE GROVE MN 55311 US
Phone
763-763-7634
Report source
M
Manufacturer link flag
Y

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1COMETTRANSDUCER, PRESSURE, CATHETER TIPBOSTON SCIENTIFIC CORPORATIONDXO890089000024100281Y R

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12020-01-080

Event Narratives#

N

Patient 1

DEVICE RETURNED TO MANUFACTURER: THE COMET PRESSURE GUIDEWIRE WAS RETURNED AND ANALYSIS WAS COMPLETED. THE TIP, DEVICE SHAFT, SENSOR PORT AND THE COEFFICIENT VALUES WERE EXAMINED FOR DAMAGE OR ANY IRREGULARITIES. THE WIRE SHOWED KINKS ON THE SHAFT LOCATED 113.5CM AND 175.5CM FROM THE TIP AND AT THE OCC HANDLE. THERE WAS SOME PEELED COATING AT THE 175.5CM LOCATION. THE TIP SHOWED BEND DAMAGE AND STRETCHED COILS. THE OCC HANDLE WAS CONNECTED TO THE FFR LINK FOR SIGNAL VERIFICATION. THE SIGNAL WAS NOT PRESENT AS DESIGNED. THE SENSOR PORT WAS INSPECTED TO VERIFY THAT THE SENSOR WAS CONNECTED TO THE FIBER OPTIC. IT WAS NOTICED THAT THE SENSOR WAS IN THE CORRECT LOCATION IN THE SENSOR PORT. THE WIRE WAS GENTLY MOVED BACK AND FORTH TO SEE IF THE SENSOR WOULD MOVE. THE SENSOR DID NOT MOVE WHICH VERIFIES THAT THE FIBER OPTICS WERE CONNECTED TO THE SENSOR. THE PROXIMAL END OF THE WIRE WAS INSPECTED FOR ANY FIBER OPTIC CRACKS OR DAMAGE AND THAT IS WAS POLISHED CORRECTLY. THE WIRE END SHOWED NO DAMAGE. THE GUIDEWIRE TIP WAS REMOVED TO VIEW THE SENSOR AND TO VERIFY THAT THE SENSOR WAS NOT CRACKED OR DAMAGED. THE SENSOR APPEARED TO BE CRACKED AND SHOWED DAMAGE. THE OCC HANDLE CAP WAS LOOSENED TO REMOVE THE WIRE. THERE WAS NO ISSUE WITH REMOVING THE WIRE. THE SENSOR PORT SHOWED RESIDUE OF BODY FLUIDS. INSPECTION OF THE REMAINDER OF THE DEVICE, APART FROM THE OBSERVED DAMAGE, REVEALED NO OTHER DAMAGE OR IRREGULARITIES.

D

Patient 1

REPORTABLE BASED ON ANALYSIS COMPLETED 18 DEC 2019. IT WAS REPORTED THAT THE ERROR MESSAGE 3015 WAS DISPLAYED AND THE COMET PRESSURE GUIDEWIRE COULD NOT BE USED. RETURNED DEVICE ANALYSIS REVEALED SOME SLIGHT PEELING OF THE DEVICE COATING.