MAUDE MDR 9872239

MDR report key
9872239
Report number
2134265-2020-03676
Event key
0
Event type
3
Date of event
2019-08-01
Date received
2020-03-24
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 CORPORATIONDXO890089000024535205Y R

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12020-03-240

Event Narratives#

N

Patient 1

DATE OF EVENT: THE DATE OF EVENT IS UNKNOWN. BSC BECAME AWARE OF THE EVENT ON (B)(6) 2019. A DATE OF (B)(6) 2020 WAS ENTERED TO INDICATE THAT THE EVENT OCCURRED ON AN UNKNOWN DAY IN (B)(6) 2019. DEVICE EVAL BY MFR: THE PRODUCT WAS RETURNED FOR ANALYSIS. THE RETURNED PRODUCT CONSISTED OF AN FFR COMET PRESSURE WIRE CONNECTED TO THE OCC CABLE. THE TIP, DEVICE SHAFT, SENSOR PORT AND THE COEFFICIENT VALUES WERE EXAMINED FOR DAMAGE OR ANY IRREGULARITIES. THE DEVICES SHAFT SHOWED 1 KINK LOCATED 162CM FROM THE TIP. THERE WAS SOME PEELING OF THE COATING AT THE 162CM LOCATION. THE SENSOR PORT SHOWED NO RESIDUE OF BODY FLUIDS. THE OCC HANDLE WAS CONNECTED TO THE FFR LINK TO VERIFY THE SIGNAL STRENGTH. THE SIGNAL WAS PRESENT AS DESIGNED. THE OCC HANDLE WAS THEN CONNECTED TO THE BENCH TOP TESTING EQUIPMENT AND THE WIRE WAS INSERTED INTO THE PRESSURE CHAMBER. THE PRESSURE WAS INCREASED TO VERIFY THE SENSOR WAS INDEED REACTING TO THE PRESSURE INCREASES AND DECREASES. THE PRESSURE SENSOR FUNCTIONED AS DESIGNED. THE COEFFICIENT VALUES WERE CONFIRMED TO BE PROGRAMMED. THE OCC HANDLE WAS AGAIN CONNECTED TO THE FFR LINK. THE DEVICE WAS THEN CONNECTED TO THE POLARIS (ILAB) TEST EQUIPMENT VIA BLUETOOTH SIGNAL. THE WIRE COMMUNICATED TO THE POLARIS SYSTEM AND ZEROED AS DESIGNED. THE WIRE WAS INSERTED INTO THE TEST PRESSURE CHAMBER AND THE WIRE TRANSFERRED A PRESSURE WAVEFORM TO THE POLARIS WHICH INDICATES A FUNCTIONING WIRE. THE WIRE WAS REMOVED FROM THE OCC HANDLE WITH NO ISSUES. INSPECTION OF THE REMAINDER OF THE DEVICE, APART FROM THE OBSERVED DAMAGE, REVEALED NO OTHER DAMAGE OR IRREGULARITIES. DEVICE ANALYSIS DETERMINED THE CONDITION OF THE RETURNED DEVICE WAS NOT CONSISTENT WITH THE REPORTED INFORMATION.

D

Patient 1

REPORTABLE BASED ON DEVICE ANALYSIS COMPLETED ON 28FBE2020. IT WAS REPORTED THAT A SIGNAL COULD NOT BE DETECTED FROM A PRESSURE GUIDEWIRE. A COMET PRESSURE GUIDEWIRE WAS USED, BUT A SIGNAL COULDN'T BE DETECTED ANYMORE. IT WAS NOTED THAT THE PROBLEM OCCURRED WHILE CONNECTING TO THE FFR LINK. THE DEVICE WAS REMOVED AND THE PROCEDURE WAS COMPLETED WITH A NON BSC DEVICE. NO PATIENT COMPLICATIONS RESULTED IN RELATION TO THIS EVENT. HOWEVER, RETURNED DEVICE ANALYSIS REVEALED PEELED COATING.