FDA Adverse Event Injury Summary report: N

OPTICROSS? HD

MDR report key: 21353186 · Received February 11, 2025

Report

Report Number
2124215-2025-05695
Event Type
Injury
Date Received
February 11, 2025
Date of Event
January 13, 2025
Report Date
May 2, 2025
Manufacturer
BOSTON SCIENTIFIC CORPORATION
Product Code
OBJ
UDI-DI
08714729960737
PMA / PMN Number
K173284
Adverse Event
Yes
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
MO, US
Reporter Occupation
PHYSICIAN
Health Professional
Yes

Narratives

Additional Manufacturer Narrative · 0

D4: LOT NUMBER: UPDATED. G4: PREMARKET / 510(K) #: K173284, K213593.

Additional Manufacturer Narrative · 0

THE DEVICE WAS RETURNED FOR ANALYSIS. VISUAL AND MICROSCOPE INSPECTIONS REVEALED THAT THE SHEATH WAS KINKED AND DETACHED, THE DRIVE SHAFT AND COAXIAL CABLE WERE BROKEN, THE IMAGING WINDOW AND DRIVE CABLE WERE TWISTED, AND THE IMAGING WINDOW WAS TORN. MICROSCOPE INSPECTION ALSO REVEALED THAT THE GUIDEWIRE EXIT PORT WAS LIFTED, BUT THE DISTAL SECTION OF THE TIP WAS IN GOOD CONDITION. G4: PREMARKET / 510(K) # - K173284, K213593.

Description of Event or Problem · 0

IT WAS REPORTED THAT CATHETER ISSUE OCCURRED. THE 90% STENOSED TARGET LESION WAS LOCATED IN THE ANTERIOR TIBIAL ARTERY. THE OPTICROSS IMAGING CATHETER WAS SELECTED FOR ULTRASOUND EXAMINATION OF THE TARGET LESION. DURING THE PROCEDURE, THE INTRAVASCULAR ULTRASOUND CATHETER TWISTED UPON ITSELF. HOWEVER, THE DEVICE WAS SUCCESSFULLY RETRIEVED. THE PATIENT WAS ADMITTED TO THE HOSPITAL BEYOND THE STANDARD OF CARE.

Description of Event or Problem · 0

IT WAS REPORTED THAT CATHETER ISSUE OCCURRED. THE 90% STENOSED TARGET LESION WAS LOCATED IN THE ANTERIOR TIBIAL ARTERY. THE OPTICROSS IMAGING CATHETER WAS SELECTED FOR ULTRASOUND EXAMINATION OF THE TARGET LESION. DURING THE PROCEDURE, THE INTRAVASCULAR ULTRASOUND CATHETER TWISTED UPON ITSELF. HOWEVER, THE DEVICE WAS SUCCESSFULLY RETRIEVED. THE PATIENT WAS ADMITTED TO THE HOSPITAL BEYOND THE STANDARD OF CARE.

Description of Event or Problem · 0

IT WAS REPORTED THAT CATHETER ISSUE OCCURRED. THE 90% STENOSED TARGET LESION WAS LOCATED IN THE ANTERIOR TIBIAL ARTERY. THE OPTICROSS IMAGING CATHETER WAS SELECTED FOR ULTRASOUND EXAMINATION OF THE TARGET LESION. DURING THE PROCEDURE, THE INTRAVASCULAR ULTRASOUND CATHETER TWISTED UPON ITSELF. HOWEVER, THE DEVICE WAS SUCCESSFULLY RETRIEVED. THE PATIENT WAS ADMITTED TO THE HOSPITAL BEYOND THE STANDARD OF CARE.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1754179 OPTICROSS? HD CATHETER, ULTRASOUND, INTRAVASCULAR OBJ BOSTON SCIENTIFIC CORPORATION H74939352040 0035211509 08714729960737

Patients

Seq Age Sex Outcome Treatment
1 73 YR Male Hospitalization