FDA Adverse Event Injury Summary report: N

MARATHON MICRO CATHETER

MDR report key: 1556455 · Received December 8, 2009

Report

Report Number
2029214-2009-00325
Event Type
Injury
Date Received
December 8, 2009
Date of Event
June 5, 2009
Report Date
August 12, 2009
Manufacturer
EV3 NEUROVASCULAR
Product Code
KRA
Adverse Event
Yes
Report Source
Manufacturer report
Reporter Location
JA
Reporter Occupation
OTHER

Narratives

Additional Manufacturer Narrative · 1

THE DEVICES INVOLVED IN THIS EVENT WILL NOT BE RETURNED FOR EVALUATION. MODEL# AND LOT # OF THE ONYX USED: MODEL# 105-7100-060, LOT# 7279662 (QTY: 3EA). DOM 03/2009. EXPIRATION DATE 12/2011.

Description of Event or Problem · 1

TREATMENT OF AN AVM WITH ONYX. IT WAS REPORTED THE PHYSICIAN EMBOLIZED 3 FEEDERS OF THE AVM USING 5 MARATHON CATHETERS AND APPROXIMATELY 0.58ML OF ONYX. ONE OF THE CATHETERS WAS REPORTED OCCLUDED AND BROKEN DURING ONYX INJECTION. NO PATIENT INJURY REPORTED.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1 MARATHON MICRO CATHETER FLOW-DIRECTED MICRO CATHETER KRA EV3 NEUROVASCULAR 105-5055 UNKNOWN

Patients

Seq Age Sex Outcome Treatment
1 55 YR Required Intervention