UNKNOWN
Received Jun 2, 2017
Report 1037905-2017-00338 · MDR key 6608460
Device
Manufacturer
Cook EndoscopyCatalog number
UNKNOWN
Product problems
- Adverse Event Without Identified Device or Use Problem
- Adverse Event Without Identified Device or Use Problem
Patient
Not reported
- Tissue Damage
- No Consequences Or Impact To Patient
- Tissue Damage
- No Consequences Or Impact To Patient
Narrative
Additional Manufacturer Narrative
INVESTIGATION EVALUATION: A PRODUCT EVALUATION WAS NOT PERFORMED IN RESPONSE TO THIS REPORT BECAUSE THE PRODUCT SAID TO BE INVOLVED WAS NOT PROVIDED TO COOK FOR EVALUATION. THE REPORT COULD NOT BE CONFIRMED. A REVIEW OF THE DEVICE HISTORY RECORD COULD NOT BE CONDUCTED BECAUSE THE LOT NUMBER WAS NOT PROVIDED. INVESTIGATION CONCLUSION: WE COULD NOT CONDUCT A COMPLETE INVESTIGATION BECAUSE THE PRODUCT SAID TO BE INVOLVED WAS NOT RETURNED FOR EVALUATION. A DEFINITIVE CAUSE FOR THE REPORTED OBSERVATION COULD NOT BE DETERMINED. THE SIZE OF TISSUE SAMPLE OR BIOPSY TO BE EXCISED CAN BE CONTROLLED BY HOW THE USER HANDLES THE FORCEPS. IF EXCESSIVE PRESSURE WAS APPLIED DURING ADVANCEMENT INTO THE TISSUE OR DURING HANDLE MANIPULATION, THIS COULD HAVE CONTRIBUTED TO THE REPORTED OBSERVATION. THE INSTRUCTIONS FOR USE DIRECT THE USER TO ADVANCE THE FORCEPS INTO THE TISSUE AT THE DESIRED BIOPSY SITE. THEN THE USER IS INSTRUCTED TO CLOSE THE FORCEPS AROUND THE TISSUE WHILE USING SLIGHT PRESSURE ON THE HANDLE. THE USER IS INSTRUCTED TO MAINTAIN GENTLE HANDLE PRESSURE TO KEEP THE CUPS CLOSED AND GENTLY WITHDRAW THE FORCEPS FROM THE SITE. THE INSTRUCTIONS FOR USE UNDER THE WARNINGS SECTION STATES: "THESE SINGLE-USE FORCEPS SHOULD ONLY BE USED TO BIOPSY TISSUE WHERE POSSIBLE BLEEDING OR HEMORRHAGE WILL NOT PRESENT A DANGER FOR PATIENTS. ADEQUATE PLANS FOR MANAGEMENT OF POTENTIAL BLEEDING OR HEMORRHAGE AND APPROPRIATE AIRWAY MANAGEMENT SHOULD BE IN PLACE." THE INSTRUCTIONS FOR USE LISTS POTENTIAL COMPLICATIONS AS: "THOSE ASSOCIATED WITH GASTROINTESTINAL ENDOSCOPY INCLUDE BUT ARE NOT LIMITED TO: PERFORATION, BLEEDING OR HEMORRHAGE, ASPIRATION, FEVER, INFECTION, ALLERGIC REACTION TO MEDICATION, HYPOTENSION, RESPIRATORY DEPRESSION OR ARREST, CARDIAC ARRHYTHMIA OR ARREST." PRIOR TO DISTRIBUTION, ALL CAPTURA DISPOSABLE BIOPSY FORCEPS ARE SUBJECTED TO A VISUAL INSPECTION TO ENSURE DEVICE INTEGRITY. CORRECTIVE ACTION: A REVIEW OF THE COMPLAINT HISTORY WAS CONDUCTED. THE LIKELIHOOD OF OCCURRENCE IS CONSIDERED RARE. CORRECTIVE ACTION IS NOT WARRANTED AT THIS TIME BASED ON THE QUALITY ENGINEERING RISK ASSESSMENT. QUALITY ASSURANCE WILL CONTINUE TO MONITOR FOR COMPLAINT TRENDS AND REASSESS THE RISK ASSESSMENT RESULTS AS POST MARKET FEEDBACK CONTINUES TO BECOME AVAILABLE.
Description of Event or Problem
DURING MULTIPLE BIOPSY PROCEDURES, THE PHYSICIAN USED A COOK BIOPSY FORCEP (UNKNOWN MODEL). THE USER CLAIMS THAT "EVERY ONCE IN A WHILE, THERE IS BLEEDING POST BIOPSY".
Additional Manufacturer Narrative
INVESTIGATION EVALUATION: A PRODUCT EVALUATION WAS NOT PERFORMED IN RESPONSE TO THIS REPORT BECAUSE THE PRODUCT SAID TO BE INVOLVED WAS NOT PROVIDED TO COOK FOR EVALUATION. THE REPORT COULD NOT BE CONFIRMED. A REVIEW OF THE DEVICE HISTORY RECORD COULD NOT BE CONDUCTED BECAUSE THE LOT NUMBER WAS NOT PROVIDED. INVESTIGATION CONCLUSION: WE COULD NOT CONDUCT A COMPLETE INVESTIGATION BECAUSE THE PRODUCT SAID TO BE INVOLVED WAS NOT RETURNED FOR EVALUATION. A DEFINITIVE CAUSE FOR THE REPORTED OBSERVATION COULD NOT BE DETERMINED. THE SIZE OF TISSUE SAMPLE OR BIOPSY TO BE EXCISED CAN BE CONTROLLED BY HOW THE USER HANDLES THE FORCEPS. IF EXCESSIVE PRESSURE WAS APPLIED DURING ADVANCEMENT INTO THE TISSUE OR DURING HANDLE MANIPULATION, THIS COULD HAVE CONTRIBUTED TO THE REPORTED OBSERVATION. THE INSTRUCTIONS FOR USE DIRECT THE USER TO ADVANCE THE FORCEPS INTO THE TISSUE AT THE DESIRED BIOPSY SITE. THEN THE USER IS INSTRUCTED TO CLOSE THE FORCEPS AROUND THE TISSUE WHILE USING SLIGHT PRESSURE ON THE HANDLE. THE USER IS INSTRUCTED TO MAINTAIN GENTLE HANDLE PRESSURE TO KEEP THE CUPS CLOSED AND GENTLY WITHDRAW THE FORCEPS FROM THE SITE. THE INSTRUCTIONS FOR USE UNDER THE WARNINGS SECTION STATES: "THESE SINGLE-USE FORCEPS SHOULD ONLY BE USED TO BIOPSY TISSUE WHERE POSSIBLE BLEEDING OR HEMORRHAGE WILL NOT PRESENT A DANGER FOR PATIENTS. ADEQUATE PLANS FOR MANAGEMENT OF POTENTIAL BLEEDING OR HEMORRHAGE AND APPROPRIATE AIRWAY MANAGEMENT SHOULD BE IN PLACE." THE INSTRUCTIONS FOR USE LISTS POTENTIAL COMPLICATIONS AS: "THOSE ASSOCIATED WITH GASTROINTESTINAL ENDOSCOPY INCLUDE BUT ARE NOT LIMITED TO: PERFORATION, BLEEDING OR HEMORRHAGE, ASPIRATION, FEVER, INFECTION, ALLERGIC REACTION TO MEDICATION, HYPOTENSION, RESPIRATORY DEPRESSION OR ARREST, CARDIAC ARRHYTHMIA OR ARREST." PRIOR TO DISTRIBUTION, ALL CAPTURA DISPOSABLE BIOPSY FORCEPS ARE SUBJECTED TO A VISUAL INSPECTION TO ENSURE DEVICE INTEGRITY. CORRECTIVE ACTION: A REVIEW OF THE COMPLAINT HISTORY WAS CONDUCTED. THE LIKELIHOOD OF OCCURRENCE IS CONSIDERED RARE. CORRECTIVE ACTION IS NOT WARRANTED AT THIS TIME BASED ON THE QUALITY ENGINEERING RISK ASSESSMENT. QUALITY ASSURANCE WILL CONTINUE TO MONITOR FOR COMPLAINT TRENDS AND REASSESS THE RISK ASSESSMENT RESULTS AS POST MARKET FEEDBACK CONTINUES TO BECOME AVAILABLE.
Description of Event or Problem
DURING MULTIPLE BIOPSY PROCEDURES, THE PHYSICIAN USED A COOK BIOPSY FORCEP (UNKNOWN MODEL). THE USER CLAIMS THAT "EVERY ONCE IN A WHILE, THERE IS BLEEDING POST BIOPSY".