FDA Adverse Event Injury Summary report: N

GRAFTMASTER RX CORONARY STENT GRAFT SYSTEM

MDR report key: 13084674 · Received December 24, 2021

Report

Report Number
2024168-2021-12154
Event Type
Injury
Date Received
December 24, 2021
Date of Event
December 7, 2021
Report Date
February 18, 2022
Manufacturer
ABBOTT VASCULAR
Product Code
MAF
PMA / PMN Number
H000001
Adverse Event
Yes
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
TW
Reporter Occupation
PHYSICIAN
Health Professional
Yes

Narratives

Additional Manufacturer Narrative · 0

THE DEVICE IS EXPECTED TO BE RETURNED FOR EVALUATION. IT HAS NOT YET BEEN RECEIVED. A FOLLOW UP REPORT WILL BE SUBMITTED WITH ALL ADDITIONAL RELEVANT INFORMATION.

Additional Manufacturer Narrative · 0

A VISUAL AND DIMENSIONAL INSPECTION WAS PERFORMED ON THE RETURNED DEVICE. THE REPORTED FAILURE TO ADVANCE COULD NOT BE TESTED AS IT WAS BASED ON OPERATIONAL CIRCUMSTANCES. A REVIEW OF THE LOT HISTORY RECORD IDENTIFIED NO MANUFACTURING NONCONFORMITIES ISSUED TO THE REPORTED LOT THAT WOULD HAVE CONTRIBUTED TO THIS EVENT. ADDITIONALLY, A REVIEW OF THE COMPLAINT HISTORY DID NOT INDICATE A LOT SPECIFIC QUALITY ISSUE. THE INVESTIGATION DETERMINED THE REPORTED FAILURE TO ADVANCE APPEARS TO BE RELATED TO CIRCUMSTANCES OF THE PROCEDURE. THERE IS NO INDICATION OF A PRODUCT QUALITY ISSUE WITH RESPECT TO MANUFACTURE, DESIGN OR LABELING.NA.

Additional Manufacturer Narrative · 0

THE DEVICE IS EXPECTED TO BE RETURNED FOR EVALUATION. IT HAS NOT YET BEEN RECEIVED. A FOLLOW UP REPORT WILL BE SUBMITTED WITH ALL ADDITIONAL RELEVANT INFORMATION.

Description of Event or Problem · 0

IT WAS REPORTED THAT THE PROCEDURE WAS TO TREAT A PERFORATION IN A HEAVILY CALCIFIED, MILDLY TORTUOUS DE NOVO LEFT ANTERIOR DESCENDING ARTERY THAT IS 90% STENOSED. THE 2.80X19MM RX GRAFTMASTER FAILED TO CROSS DUE TO ANATOMY. ANOTHER SAME SIZE GRAFTMASTER WAS USED TO SUCCESSFULLY COMPLETE THE PROCEDURE. THERE WAS NO ADVERSE PATIENT EFFECTS AND NO CLINICALLY SIGNIFICANT DELAY. NO ADDITIONAL INFORMATION WAS PROVIDED.

Description of Event or Problem · 0

IT WAS REPORTED THAT THE PROCEDURE WAS TO TREAT A PERFORATION IN A HEAVILY CALCIFIED, MILDLY TORTUOUS DE NOVO LEFT ANTERIOR DESCENDING ARTERY THAT IS 90% STENOSED. THE 2.80X19MM RX GRAFTMASTER FAILED TO CROSS DUE TO ANATOMY. ANOTHER SAME SIZE GRAFTMASTER WAS USED TO SUCCESSFULLY COMPLETE THE PROCEDURE. THERE WAS NO ADVERSE PATIENT EFFECTS AND NO CLINICALLY SIGNIFICANT DELAY. NO ADDITIONAL INFORMATION WAS PROVIDED.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1982230 GRAFTMASTER RX CORONARY STENT GRAFT SYSTEM CORONARY STENT DELIVERY SYSTEM MAF ABBOTT VASCULAR 1033041

Patients

Seq Age Sex Outcome Treatment
1 Unknown Other