FDA Adverse Event Malfunction Summary report: N

ANGIOJET? SOLENT? OMNI

MDR report key: 21710123 · Received March 27, 2025

Report

Report Number
2124215-2025-14855
Event Type
Malfunction
Date Received
March 27, 2025
Date of Event
February 28, 2025
Report Date
May 9, 2025
Manufacturer
BOSTON SCIENTIFIC CORPORATION
Product Code
DXE
UDI-DI
08714729889663
PMA / PMN Number
K111182
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
UT, US
Reporter Occupation
PHYSICIAN
Health Professional
Yes

Narratives

Additional Manufacturer Narrative · 0

D2B - PRO CODE (PRODUCT CODE): KRA.

Additional Manufacturer Narrative · 0

D2B - PRO CODE (PRODUCT CODE): KRA. DEVICE EVALUATED BY MFR: THE DEVICE WAS RETURNED FOR EVALUATION. THE DEVICE REVEALED MULTIPLE SHAFT KINKS AND BUCKLING OF THE OUTER SHAFT. MICROSCOPE EXAMINATION REVEALED A HYPOTUBE SEPARATION WAS OBSERVED LOCATED AT 1 CM FROM THE TIP ALONG WITH SHAFT BUCKLING, STRETCHING AND KINKS. NO OTHER ISSUES WERE IDENTIFIED WITH THE DEVICE.

Description of Event or Problem · 0

IT WAS REPORTED THAT CATHETER BREAK OCCURRED. AN ANGIOJET SOLENT OMNI WAS SELECTED FOR USE IN A THROMBECTOMY PROCEDURE. DURING WITHDRAWAL, IT WAS NOTED THAT A CATHETER BREAK OCCURRED. THE PROCEDURE WAS COMPLETED USING THIS DEVICE. THERE WERE NO PATIENT COMPLICATIONS AS A RESULT OF THIS EVENT.

Description of Event or Problem · 0

IT WAS REPORTED THAT CATHETER BREAK OCCURRED. AN ANGIOJET SOLENT OMNI WAS SELECTED FOR USE IN A THROMBECTOMY PROCEDURE. DURING WITHDRAWAL, IT WAS NOTED THAT A CATHETER BREAK OCCURRED. THE PROCEDURE WAS COMPLETED USING THIS DEVICE. THERE WERE NO PATIENT COMPLICATIONS AS A RESULT OF THIS EVENT.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
2530087 ANGIOJET? SOLENT? OMNI CATHETER, EMBOLECTOMY DXE BOSTON SCIENTIFIC CORPORATION 109681-001 0035141565 08714729889663

Patients

Seq Age Sex Outcome Treatment
1 NA Unknown