BEUDAMED
    FDA Adverse Event Death Summary report: N

    MATRIX STRETCH RESISTANT (SR) COILS

    MDR report key: 1692327 · Received May 18, 2010

    Report

    Report Number
    2939204-2010-00227
    Event Type
    Death
    Date Received
    May 18, 2010
    Date of Event
    January 31, 2006
    Report Date
    January 31, 2006
    Manufacturer
    BOSTON SCIENTIFIC - CORK
    Product Code
    HCG
    PMA / PMN Number
    K050700
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    ES
    Reporter Occupation
    PHYSICIAN

    Narratives

    Additional Manufacturer Narrative · 1

    CONCLUSION: FOR ANTICIPATED PROCEDURAL COMPLICATION. THE DEVICE REMAINS IMPLANTED AND WAS NOT AVAILABLE FOR ANALYSIS. FROM THE INFORMATION PROVIDED, THERE WAS NO INDICATION THAT THE DEVICE WAS NOT USED AS IN ACCORDANCE WITH THE LABELING OR THAT THIS CAUSED OR CONTRIBUTED TO THE REPORTED EVENT. THROMBOSIS AND DEATH ARE KNOWN AND ANTICIPATED COMPLICATIONS TO THESE TYPES OF PROCEDURES AND ARE NOTED IN THE LABELING. THEREFORE, IT WAS DETERMINED THAT THE REPORTED EVENT WAS AN ANTICIPATED PROCEDURAL COMPLICATION.

    Description of Event or Problem · 1

    THE PATIENT UNDERWENT THE SUCCESSFUL COIL EMBOLIZATION PROCEDURE OF THE RIGHT POSTERIOR COMMUNICATING ARTERY (PCOM) ANEURYSM. THE PROCEDURE WAS COMPLICATED BY AN EMBOLISM. IMMEDIATELY FOLLOWING THE PROCEDURE THE PATIENT WAS STABLE. IT WAS REPORTED THAT THE PATIENT¿S CONDITION HAD WORSENED AND THE PATIENT EXPIRED, NO DATE WAS PROVIDED FOR THE CHANGE IN THE PATIENT¿S CONDITION. THE DATE AND THE CAUSE OF DEATH ARE UNKNOWN. NO FURTHER INFORMATION WAS PROVIDED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 MATRIX STRETCH RESISTANT (SR) COILS DEVICE, NEUROVASCULAR EMBOLIZATION HCG BOSTON SCIENTIFIC - CORK M003492720SR0

    Patients

    Seq Age Sex Outcome Treatment
    1 37 YR Death| O TWO MATRIX COILS (BOSTON SCIENTIFIC)| EXCELSIOR 10 CATHETER (BOSTON SCIENTIFIC)