MAUDE MDR 9604734

MDR report key
9604734
Report number
2017233-2020-00046
Event key
0
Event type
3
Date of event
2018-10-04
Date received
2020-01-18
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
SIBYLLE STAERK
Address
1500 N. 4TH STREET AZ
Phone
928-928-9285
Report source
M
Manufacturer link flag
Y

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1GORE-TEX? VASCULAR GRAFTPROSTHESIS, VASCULAR GRAFTW.L. GORE & ASSOCIATESDSYR N

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12020-01-1801. H

Event Narratives#

N

Patient 1

(B)(6) 2018 WAS TAKEN AS THE DATE OF EVENT, BECAUSE THE INFECTION WAS DIAGNOSED ON THIS DATE. ON (B)(6) 2018 WAS TAKEN AS THE BEST ESTIMATE OF THE DATE OF IMPLANT. THE PHONE NUMBER OF THE PHYSICIAN COULD NOT BE OBTAINED. THE INVESTIGATION INVOLVED E-MAIL COMMUNICATION WITH THE HEALTHCARE PROFESSIONAL PERFORMING THE EXPLANT EVALUATION.THE EXPLANTED DEVICE WAS NOT RETURNED TO GORE FOR EVALUATION. AT PRESENT THE DEVICE IS LOCATED AT AN INDEPENDED LABORATORY (B)(6). THE INDEPENDED LABORATORY GEPROVAS PROVIDED GORE WITH A PRELIMINARY EXPLANT EVALUATION. NO ANALYSIS OF RELEVANT PRODUCTION RECORDS IN VIEW OF SUPPORTING THE IDENTIFICATION OF POSSIBLE CAUSES FOR THE ADVERSE EVENT COULD BE PERFORMED, BECAUSE THE LOT NUMBER OF THE DEVICE REMAINS UNKNOWN.

D

Patient 1

A GORE-TEX? VASCULAR GRAFT WAS IMPLANTED IN A (B)(6) FEMALE PATIENT IN (B)(6) 2018 AS A FEMORO-FEMORAL BYPASS IN ORDER TO TREAT A CRITICAL ISCHEMIA. REPORTEDLY THE PATIENT DID NOT HAVE A HISTORY OF PRE-EXISTING INFECTION IN THE FIELD OF TREATMENT. IT WAS REPORTED, THAT, ON (B)(6) 2018, AN INFECTION WAS IDENTIFIED. IT WAS STATED, THAT ON (B)(6) 2018, IMAGING WAS PERFORMED PRESENTING AN ANASTOMOTIC PSEUDOANEURYSM AND A POSSIBLE BREACH NEAR THE ANASTOMOSIS. REPORTEDLY, ON (B)(6) 2018, THE GORE-TEX? VASCULAR GRAFT WAS EXPLANTED DUE TO THE INFECTION AND THE PSEUDOANEURYSM. IT WAS REPORTED, THAT THE SURGEON PERFORMED A PROSTHETO-PROSTHETIC BYPASS TO REPAIR THE ISSUE LOCALLY. IT WAS STATED, THAT THE PATIENT RECEIVED ANTIPYRETIC AND ANTIBIOTIC TREATMENT. IT WAS REPORTED, THAT THE PATIENT IS DOING WELL. IN THE PROVIDED EXPLANT REPORT IT IS STATED, THAT THE GORE-TEX? VASCULAR GRAFT WAS SEPARATED IN TWO SEGMENTS. ONE OF THIS EXPLANTED SEGMENTS REVEALED A TOTAL OBSTRUCTION OF THE PROSTHETIC LUMEN DUE TO THE LOSS OF SOME REINFORCEMENT RINGS ALLOWING THE GRAFT TO COLLAPSE. MOREOVER, A GREEN MULTIFILAMENT HAS BEEN USED AS A LIGATURE. THE PHYSICIAN STATED, THAT THE INFECTION WAS NEITHER CAUSED BY THE GORE-TEX? VASCULAR GRAFT NOR DID THE GORE-TEX? VASCULAR GRAFT CONTRIBUTE TO THE INFECTION. THE PHYSICIAN ALSO STATED, THAT THE INFECTION WAS NEITHER CAUSED BY THE PROCEDURE TO IMPLANT THE GORE-TEX? VASCULAR GRAFT NOR DID THE PROCEDURE CONTRIBUTE TO THE INFECTION.