FDA Adverse Event Injury Summary report: N

VERIFLEX LIBERTE' CORONARY STENT DELIVERY SYSTEM

MDR report key: 1770005 · Received July 25, 2010

Report

Report Number
2134265-2009-06341
Event Type
Injury
Date Received
July 25, 2010
Date of Event
August 5, 2006
Report Date
August 5, 2006
Manufacturer
BOSTON SCIENTIFIC IRELAND LTD.
Product Code
MAF
PMA / PMN Number
P040016
Adverse Event
Yes
Report Source
Manufacturer report
Reporter Location
HU
Reporter Occupation
PHYSICIAN

Narratives

Additional Manufacturer Narrative · 1

THE DEVICE WILL NOT BE RETURNED FOR EVALUATION; THEREFORE A FAILURE ANALYSIS OF THE COMPLAINT DEVICE COULD NOT BE COMPLETED. THE BATCH NUMBER IS UNKNOWN THEREFORE, A REVIEW OF THE MANUFACTURING DOCUMENTATION COULD NOT BE PERFORMED. THE MOST PROBABLE ROOT CAUSE CLASSIFICATION OF ANTICIPATED PROCEDURAL COMPLICATIONS. THIS COMPLAINT IS DUE TO A KNOWN PHYSIOLOGICAL EFFECT OF THE PROCEDURE NOTED WITHIN THE DIRECTIONS FOR USE. (B)(4) : DEVICE NOT RETURNED FOR ANALYSIS.

Description of Event or Problem · 1

(B)(4). IT WAS REPORTED THAT DURING A CORONARY ARTERY STENTING TREATMENT PROCEDURE, THROMBUS OCCURRED. THE TARGET LESION WAS LOCATED IN THE LEFT ANTERIOR DESCENDING. THE TARGET VESSEL REFERENCE DIAMETER WAS 3.2MM AND THE LESION LENGTH WAS 16MM. PRE-PROCEDURE STENOSIS WAS 74%. POST-PROCEDURE WAS 6% STENOSIS. A 3.5X20MM LIBERTE STENT WAS IMPLANTED. A NON BSC BALLOON CATHETER WAS ALSO USED. DIRECT STENTING WAS NOT ATTEMPTED. THROMBUS ASPIRATION WAS COMPLETED TO REMOVE THROMBUS. THE PROCEDURE WAS A TECHNICAL SUCCESS. THE PATIENT WAS DISCHARGED THREE DAYS LATER WITHOUT CURRENT ANGINAL COMPLAINTS OR SILENT ISCHEMIA. DISCHARGE MEDICATION INCLUDES: ASA 100MG AND CLOPIDOGREL 75MG DAILY FOR 12 MONTHS.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1 VERIFLEX LIBERTE' CORONARY STENT DELIVERY SYSTEM STENT, CORONARY MAF BOSTON SCIENTIFIC IRELAND LTD.

Patients

Seq Age Sex Outcome Treatment
1 72 YR Required Intervention SPRINTER BALLOON CATHETER