inforMED
MalfunctionFFT

BRAVO

Received May 27, 2026 · Event occurred Apr 30, 2026

Report 9710107-2026-00250 · MDR key 25302424

Device

Generic name

Electrode, Ph, Stomach

Model number

FGS-0635

Catalog number

FGS-0635

Lot number

68485F

Product problems

  • Separation Failure

Patient

61 YR · Female

  • Hemorrhage/Blood Loss/Bleeding

Narrative

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.

Description of Event or Problem

IT WAS REPORTED THAT THE CAPSULE FAILED TO DETACH FROM THE DELIVERY SYSTEM DURING USE AND THE PHYSICIAN HAD TO BREAK THE HANDLE. THE CAPSULE WAS STILL ATTACHED TO THE DELIVERY DEVICE WHEN IT WAS REMOVED. A SECOND ATTEMPT TO PLACE A CAPSULE WAS PERFORMED AND THE CAPSULE WAS SUCCESSFULLY ATTACHED. THE PATIENT EXPERIENCED MINOR BLEEDING. LUBRICATION DID NOT COVER THE SUCTION CHAMBER.