BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    STERLING BALLOON DILATATION CATHETER

    MDR report key: 1884809 · Received October 28, 2010

    Report

    Report Number
    2134265-2010-04809
    Event Type
    Malfunction
    Date Received
    October 28, 2010
    Date of Event
    October 6, 2010
    Report Date
    October 7, 2010
    Manufacturer
    BOSTON SCIENTIFIC - MAPLE GROVE
    Product Code
    DQY
    PMA / PMN Number
    K053118
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Occupation
    PHYSICIAN

    Narratives

    Additional Manufacturer Narrative · 1

    (B)(4): THE COMPLAINT DEVICE WAS NOT RETURNED FOR ANALYSIS; THEREFORE A FAILURE ANALYSIS OF THE DEVICE COULD NOT BE COMPLETED. THE MANUFACTURING BATCH RECORD REVIEW CONFIRMED THAT THE DEVICE MET ALL MATERIAL, ASSEMBLY AND PERFORMANCE SPECIFICATIONS. THE MOST PROBABLE ROOT CAUSE IS OPERATIONAL CONTEXT AS DEVICE PERFORMANCE WAS LIMITED DUE TO ANATOMICAL/PROCEDURAL FACTORS.(B)(4)

    Description of Event or Problem · 1

    IT WAS REPORTED THAT DURING A PERCUTANEOUS TRANSLUMINAL ANGIOPLASTY TREATMENT PROCEDURE, A BALLOON RUPTURE OCCURRED. THE 100% STENOSED TARGET LESION WAS LOCATED IN THE MODERATELY TORTUOUS RIGHT EXTERNAL ILIAC ARTERY (EIA). THE 4.0 X 60 STERLING BALLOON CATHETER WAS ADVANCED OVER A NON BSC GUIDE WIRE FOR PRE-DILATATION. DURING THE FIRST INFLATION, THE BALLOON RUPTURED AT 6 ATMS. THE PROCEDURE WAS COMPLETED AFTER SUCCESSFUL IMPLANTATION AND POST-DILATATION OF AN UNSPECIFIED STENT. THERE WERE NO PATIENT COMPLICATIONS REPORTED AND THE PATIENT'S STATUS IS GOOD.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 STERLING BALLOON DILATATION CATHETER CATHETER, PERCUTANEOUS DQY BOSTON SCIENTIFIC - MAPLE GROVE H74939031406010 13479835

    Patients

    Seq Age Sex Outcome Treatment
    1 6FR DESTINATION INTRODUCER SHEATH| ATHLETE LUBI GUIDE WIRE