BEUDAMED
    FDA Adverse Event Other Summary report: N

    PROTEGE EVERFLEX SELF EXPANDING NITINOL STENT

    MDR report key: 1566926 · Received December 23, 2009

    Report

    Report Number
    2183870-2009-00209
    Event Type
    Other
    Date Received
    December 23, 2009
    Date of Event
    December 9, 2009
    Report Date
    December 10, 2009
    Manufacturer
    EV3 INC.
    Product Code
    FGE
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    NH, US
    Reporter Occupation
    PHYSICIAN

    Narratives

    Additional Manufacturer Narrative · 1

    A REVIEW OF THE DEVICE HISTORY RECORD FOR THIS DEVICE DID NOT REVEAL ANY DISCREPANCIES RELEVANT TO THIS REPORTED EVENT.

    Description of Event or Problem · 1

    THIS PROCEDURE WAS PERFORMED ON SFA. THE PHYSICIAN DEPLOYED A PROTEGE EVERFLEX STENT AND UPON REMOVAL OF THE DELIVERY CATHETER A PORTION OF THE TIP OF THE CATHETER "BROKE OFF". THE PHYSICIAN WAS ABLE TO RETRIEVE IT WITHOUT ANY INCIDENT OR REPERCUSSION FOR THE PATIENT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 PROTEGE EVERFLEX SELF EXPANDING NITINOL STENT FGE EV3 INC. PRB35-060-150-120 7853411

    Patients

    Seq Age Sex Outcome Treatment
    1 74 YR Required Intervention