BRAVO
Received Jun 2, 2026 · Event occurred May 8, 2026
Report 9710107-2026-00263 · MDR key 25361629
Device
Generic name
Electrode, Ph, Stomach
Manufacturer
Given Imaging Ltd., YoqneamModel number
FGS-0635Catalog number
FGS-0635
Lot number
67487F
Product problems
- Separation Failure
Patient
60 YR · Male
- No Clinical Signs, Symptoms or Conditions
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. THE PHYSICIAN BROKE THE HANDLE BUT THE CAPSULE WAS STILL ATTACHED TO THE DELIVERY DEVICE WHEN REMOVED. THE PROCEDURE WAS COMPLETED BY USING A DIFFERENT DELIVERY DEVICE. NO LUBRICANT WAS USED TO FACILITATE THE PLACEMENT OF THE CAPSULE. THERE WAS NO PATIENT OR USER HARM.