inforMED
MalfunctionFFT

BRAVO

Received May 18, 2026 · Event occurred Apr 22, 2026

Report 9710107-2026-00220 · MDR key 25203141

Device

Generic name

Electrode, Ph, Stomach

Model number

FGS-0635

Catalog number

FGS-0635

Lot number

67844F

Product problems

  • Separation Failure

Patient

NA · Male

  • No Clinical Signs, Symptoms or Conditions

Narrative

Description of Event or Problem

IT WAS REPORTED THAT AFTER THE PLUNGER WITH GOOD RECOIL WAS PRESSED, THE TWO CAPSULES FAILED TO ATTACHED TO THE MUCOSA AND REMAINED ATTACHED FROM THE DELIVERY DEVICE UPON REMOVAL. THE THIRD CAPSULE WAS USED FROM A DIFFERENT BOX AND IT WAS ATTACHED SUCCESSFULLY. THERE WAS NOTHING UNUSUAL ABOUT THE PATIENT OR THE PROCEDURE. THERE WAS NO PATIENT OR USER HARM.

Additional Manufacturer Narrative

D10 CONCOMITANT PRODUCT: FGS-0635, FGS-0635 CF DELIVERY DEV CAPS BRAVO X5 (LOT#67844F). 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.