BEUDAMED
    FDA Adverse Event Injury Summary report: N

    WALLSTENT RX BILIARY ENDOPROSTHESIS

    MDR report key: 1153357 · Received September 5, 2008

    Report

    Report Number
    3005099803-2008-04350
    Event Type
    Injury
    Date Received
    September 5, 2008
    Date of Event
    November 20, 2003
    Report Date
    August 7, 2008
    Manufacturer
    BOSTON SCIENTIFIC
    Product Code
    FGE
    PMA / PMN Number
    K012752
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    VA, US
    Reporter Occupation
    PHYSICIAN

    Narratives

    Additional Manufacturer Narrative · 1

    THE COMPLAINANT INDICATED THAT THE DEVICE WILL NOT BE RETURNED FOR EVALUATION, THEREFORE, A FAILURE ANALYSIS OF THE COMPLAINT DEVICE COULD NOT BE COMPLETED. A REVIEW OF COMPLAINTS REPORTED FOR THIS PRODUCT FAMILY FOUND A NEUTRAL TREND FOR THE PERIOD OF MAY 2008 TO JULY 2008.

    Description of Event or Problem · 1

    RETROSPECTIVE AND PROSPECTIVE CHART REVIEW AND ANALYSIS OF ENDOSCOPIC TREATMENT BY BILIARY STENTS. IT WAS REPORTED THAT APPROXIMATELY 3 MONTHS POST AN RX WALLSTENT PERMALUME 10MM X 80MM STENT PLACEMENT IN THE MID COMMON BILE DUCT (CBD), THE PATIENT EXPERIENCED RECURRENT OBSTRUCTIVE SYMPTOMS DUE TO MISPLACEMENT AND STENT MIGRATION. THE PATIENT UNDERWENT A STENT REMOVAL PROCEDURE AT WHICH TIME IT WAS NOTED THAT THE STENT HAD MIGRATED TO THE DUODENUM AND WAS REMOVED UTILIZING AN UNSPECIFIED SNARE AND EXTRACTION BALLOON. A WALLSTENT PERMALUME 10MM X 40MM STENT WAS PLACED AND THE PROCEDURE WAS COMPLETED. IT WAS NOTED THAT THE PATIENT'S CONDITION RESOLVED WITH STENT REMOVAL AND REPLACEMENT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 WALLSTENT RX BILIARY ENDOPROSTHESIS FGE BOSTON SCIENTIFIC M00569720

    Patients

    Seq Age Sex Outcome Treatment
    1 72 YR Required Intervention