inforMED
MalfunctionFFL

NCIRCLE DELTA WIRE TIPLESS STONE EXTRACTOR

Received Jun 5, 2026 · Event occurred May 22, 2026

Report 1820334-2026-00597 · MDR key 25414244

Device

Generic name

Ffl, Dislodger, Stone, Basket, Ureteral, Metal

Manufacturer

Cook Inc

Model number

G19110

Catalog number

NTSED-024115-UDH

Lot number

UNKNOWN

Product problems

  • Break

Patient

30 YR · Female

  • No Clinical Signs, Symptoms or Conditions

Narrative

Description of Event or Problem

IT WAS REPORTED THAT THE NCIRCLE DELTA WIRE TIPLESS STONE EXTRACTOR WAS TAKEN OUT TO USE AND IMMEDIATELY KINKED NEAR THE HANDLE. THE BASKET WOULD NOT OPEN AND CLOSE. AS REPORTED, THE PATIENT DID NOT EXPERIENCE ANY ADVERSE EFFECTS OR REQUIRE ANY ADDITIONAL PROCEDURES DUE TO THIS OCCURRENCE.

Additional Manufacturer Narrative

E1 - (B)(6). G4 - PMA/510(K) #: EXEMPT. H3 - DEVICE HAS BEEN RETURNED AND PRELIMINARY EVALUATION HAS BEEN PERFORMED, HOWEVER, OUR INVESTIGATION IS ONGOING AND DEVICE EVALUATION SUMMARY WILL BE INCLUDED IN OUR FOLLOW UP REPORT ONCE OUR INVESTIGATION HAS BEEN COMPLETED. THIS REPORT INCLUDES INFORMATION KNOWN AT THIS TIME. A FOLLOW UP REPORT WILL BE SUBMITTED SHOULD ADDITIONAL RELEVANT INFORMATION BECOME AVAILABLE. THIS REPORT IS REQUIRED BY THE FDA UNDER 21 CFR PART 803. THIS REPORT IS BASED ON UNCONFIRMED INFORMATION SUBMITTED BY OTHERS. NEITHER THE SUBMISSION OF THIS REPORT NOR ANY STATEMENT MADE IN IT IS INTENDED TO BE AN ADMISSION THAT ANY COOK DEVICE IS DEFECTIVE OR MALFUNCTIONED; THAT A DEATH OR SERIOUS INJURY OCCURRED; OR THAT ANY COOK DEVICE CAUSED OR CONTRIBUTED TO; OR IS LIKELY TO CAUSE OR CONTRIBUTE TO A DEATH OR SERIOUS INJURY IF A MALFUNCTION OCCURRED.