BEUDAMED
    FDA Adverse Event Injury Summary report: N

    ENROUTE NEUROPROTECTION SYSTEM

    MDR report key: 11881856 · Received May 25, 2021

    Report

    Report Number
    3014526664-2021-00072
    Event Type
    Injury
    Date Received
    May 25, 2021
    Date of Event
    May 5, 2021
    Report Date
    May 25, 2021
    Manufacturer
    SILK ROAD MEDICAL INC.
    Product Code
    NTE
    UDI-DI
    00811311020829
    PMA / PMN Number
    K153485
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    TX, US
    Reporter Occupation
    PHYSICIAN

    Narratives

    Additional Manufacturer Narrative · 1

    THE PRODUCT ASSOCIATED WITH THIS COMPLAINT WAS NOT RETURNED TO THE MANUFACTURER FOR ANALYSIS. A REVIEW OF THE MANUFACTURING RECORDS FOR THIS DEVICE WAS COMPLETED AND NO ISSUES WERE IDENTIFIED THAT COULD HAVE LED TO THE ADVERSE EVENT REPORTED. COMPLAINTS WILL CONTINUE TO BE REVIEWED AND MONITORED FOR TRENDS.

    Description of Event or Problem · 1

    IT WAS REPORTED THAT DURING A TRANSCAROTID ARTERY REVASCULARIZATION (TCAR) PROCEDURE, THE PHYSICIAN LOST THE J-WIRE AND A DISSECTION OCCURRED ON THE RIGHT COMMON CAROTID ARTERY DURING THE PLACEMENT OF THE ARTERIAL SHEATH.THE PHYSICIAN CONVERTED TO A CAROTID ENDARTERECTOMY AS A RESULT OF THE EVENT. THERE WAS NO REPORTED PATIENT HARM OR ADVERSE CONSEQUENCE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    772469 ENROUTE NEUROPROTECTION SYSTEM TEMPORARY CAROTID CATHETER FOR EMBOLIC CAPTURE NTE SILK ROAD MEDICAL INC. SR-200-NPS 301636 00811311020829

    Patients

    Seq Age Sex Outcome Treatment
    1 69 YR Required Intervention