MAUDE MDR 9702500

MDR report key
9702500
Report number
2126666-2020-00011
Event key
0
Event type
3
Date of event
2019-12-20
Date received
2020-02-12
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. SHARON SEIFERT
Address
340 LAKE HAZELTINE DRIVE CHASKA, MN US
Phone
641-641-6418
Report source
M
Manufacturer link flag
Y

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1PREFORM GUIDEWIRE - SAFARI2WIRE GUIDELAKE REGION MEDICALDQXY R

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12020-02-120

Event Narratives#

N

Patient 1

THE SAFARI2 GUIDEWIRE IS EXPECTED TO BE RETURNED FOR FAILURE ANALYSIS BUT WAS NOT RECEIVED AT THE TIME THIS REPORT WAS FILED. LOT TRACEABILITY WAS NOT PROVIDED. THE LACK OF LOT TRACEABILITY PREVENTS PERFORMING A DEVICE HISTORY RECORDS REVIEW FOR ANY INDICATION OF MANUFACTURING DEFECT OR ANOMALY THAT COULD HAVE IMPACTED ON THE EVENT AS REPORTED. A REVIEW OF THE MANUFACTURING PROCESSES INDICATES THAT DURING MANUFACTURING AND PACKAGING OF THIS PRODUCT THE OPERATORS ARE INSTRUCTED TO 100% VISUALLY INSPECT FOR ANY OBVIOUS DEFECT PRIOR TO SHIPMENT. AT THIS TIME, IT IS NOT POSSIBLE TO ASSIGN A DEFINITIVE ROOT CAUSE FOR THE EVENT AS REPORTED. BASED ON THE INFORMATION PROVIDED, IT APPEARS THAT CLINICAL AND/OR PROCEDURAL FACTORS MAY HAVE CONTRIBUTED TO THE EVENT AS REPORTED. IF ADDITIONAL INFORMATION IS RECEIVED OR PRODUCT IS RETURNED FOR ANALYSIS A FOLLOW-UP MEDWATCH REPORT WILL BE SUBMITTED.

D

Patient 1

AS REPORTED BY THE DISTRIBUTOR, PATIENT WAS UNDERGOING A TRANSCATHETER AORTIC VALVE REPLACEMENT. EVENT DESCRIPTION: IT WAS REPORTED THAT: RECAPTURE OF SECOND VALVE, WIRE WAS STUCK DUE TO OVERSEATED NOSECONE. VALVE RECAPTURED FINE, OVERSEATING WAS CORRECTED, 2ND LE AND SAFARI2 WERE REMOVED TOGETHER BECAUSE WIRE WAS STUCK. REGAINED ACCESS WITH ANOTHER SAFARI2 WIRE. NO PATIENT COMPLICATIONS.