inforMED
MalfunctionFBO

INNER SHEATH ONLY

Received Dec 16, 2020

Report 9610617-2020-00145 · MDR key 11021695

Device

Generic name

Inner Sheath

Model number

27050CA

Lot number

UQ07

Product problems

  • Material Integrity Problem
  • Material Integrity Problem

Patient

Not reported

  • Foreign Body In Patient
  • Patient Problem/Medical Problem
  • Foreign Body In Patient
  • Patient Problem/Medical Problem

Narrative

Additional Manufacturer Narrative

ITEM WAS FOUND THE BEAK WAS BROKEN AND MISSING THE STOPCOCK MANIFOLD. THIS TYPE OF OCCURRENCE MOST LIKELY IS RELATED TO MECHANICAL FORCE.

Description of Event or Problem

ALLEGEDLY, THE CERAMIC DISTAL TIP OF THE INNER SHEATH BROKE OFF INTO THE PATIENT'S BLADDER AND WAS SUCCESSFULLY RETRIEVED.