inforMED
InjuryFFT

BRAVO

Received Apr 27, 2026 · Event occurred Apr 2, 2026

Report 9710107-2026-00169 · MDR key 25000239

Device

Generic name

Electrode, Ph, Stomach

Model number

FGS-0635

Catalog number

FGS-0635

Lot number

67110F

Product problems

  • Difficult or Delayed Separation

Patient

55 YR · Female

  • Pain
  • Discomfort

Narrative

Description of Event or Problem

IT WAS REPORTED THAT THE CAPSULE ATTACHED TO THE PATIENT¿S ESOPHAGUS BUT FAILED TO DETACH. THE PATIENT EXPERIENCED DISCOMFORT AND PAIN, AND ENDOSCOPIC REMOVAL OF THE CAPSULE WAS PERFORMED.

Additional Manufacturer Narrative

MEDTRONIC SUBMITS THIS REPORT TO COMPLY WITH FDA REGULATIONS 21 CFR PARTS 4 AND 803. MEDTRONIC HAS MADE REASONABLE EFFORTS TO PROVIDE AS MUCH RELEVANT INFORMATION AS IS AVAILABLE TO THE COMPANY AS OF THE SUBMISSION DATE OF THIS REPORT. THIS REPORT DOES NOT CONSTITUTE AN ADMISSION OR A CONCLUSION BY FDA, MEDTRONIC, OR ITS EMPLOYEES THAT THE DEVICE, MEDTRONIC, OR ITS EMPLOYEE CAUSED OR CONTRIBUTED TO THE EVENT DESCRIBED IN THE REPORT. ANY REQUIRED FIELDS THAT ARE UNPOPULATED ARE BLANK BECAUSE THE INFORMATION IS CURRENTLY UNKNOWN OR UNAVAILABLE. MEDTRONIC WILL SUBMIT A SUPPLEMENTAL REPORT IF ADDITIONAL RELEVANT INFORMATION BECOMES KNOWN.