FDA Adverse Event Malfunction Summary report: N

ANGIOJET? SOLENT? DISTA

MDR report key: 22994902 · Received September 8, 2025

Report

Report Number
2124215-2025-62493
Event Type
Malfunction
Date Received
September 8, 2025
Date of Event
August 12, 2025
Report Date
September 8, 2025
Manufacturer
BOSTON SCIENTIFIC CORPORATION
Product Code
DXE
UDI-DI
08714729889731
PMA / PMN Number
K113363
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
IL, US
Reporter Occupation
PHYSICIAN
Health Professional
Yes

Narratives

Additional Manufacturer Narrative · 0

D2B - PRO CODE (PRODUCT CODE): DXE, KRA. GOOD FAITH EFFORT ATTEMPTS WERE MADE TO TRY AND RETRIEVE ADDITIONAL DETAILS REGARDING THE REPORTED EVENT, PATIENT INFORMATION, AND INITIAL REPORTER, BUT FURTHER INFORMATION WAS UNABLE TO BE OBTAINED. IF ADDITIONAL DETAILS BECOME AVAILABLE, A SUPPLEMENTAL REPORT WILL BE SUBMITTED.

Description of Event or Problem · 0

IT WAS REPORTED THAT PROCEDURE WAS CANCELLED. AN ANGIOJET SOLENT DISTA SOLENT DISTA CATHETER WAS SELECTED FOR USE. HOWEVER, DURING THE PROCEDURE, IT WAS NOTED THAT THE BECAME KINKED AND A SALINE ERROR MESSAGE DISPLAYED. ANOTHER ANGIOJET SOLENT DISTA WAS SELECTED. CONSEQUENTLY, THE DEVICE STOPPED WORKING DUE TO AN ERROR MESSAGE. THE ANGIOJET CONSOLE WAS TURNED OFF AND BACK ON BUT THAT DID NOT RESOLVE THE CATHETER ERROR. THE PROCEDURE WAS CANCELLED. THERE WERE NO PATIENT COMPLICATIONS AS A RESULT OF THIS EVENT.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
2056612 ANGIOJET? SOLENT? DISTA CATHETER, EMBOLECTOMY DXE BOSTON SCIENTIFIC CORPORATION 111303-001 0035069556 08714729889731

Patients

Seq Age Sex Outcome Treatment
1 NA Unknown