FDA Adverse Event Injury Summary report: N

SYNERGY XD

MDR report key: 23037277 · Received September 12, 2025

Report

Report Number
2124215-2025-63039
Event Type
Injury
Date Received
September 12, 2025
Date of Event
September 4, 2025
Report Date
October 28, 2025
Manufacturer
BOSTON SCIENTIFIC CORPORATION
Product Code
NIQ
UDI-DI
08714729980278
Adverse Event
Yes
Report Source
Manufacturer report
Reporter Location
IN
Reporter Occupation
PHYSICIAN
Health Professional
Yes

Narratives

Additional Manufacturer Narrative · 0

E1 INITIAL REPORTER ADDRESS: (B)(6).

Additional Manufacturer Narrative · 0

E1 INITIAL REPORTER ADDRESS: (B)(6).

Description of Event or Problem · 0

IT WAS REPORTED THAT A DISSECTION OCCURRED. THE PATIENT PRESENTED WITH AN INFERIOR WALL MYOCARDIAL INFARCTION. THE TARGET LESION WAS LOCATED IN THE PROXIMAL RIGHT CORONARY ARTERY. A 2.75 X 28MM SYNERGY XD DRUG-ELUTING STENT (DES) WAS DEPLOYED. POST DEPLOYMENT, A TYPE B FLOW-LIMITING DISTAL STENT EDGE DISSECTION WAS OBSERVED, WITH TIMI II FLOW NOTED. THE DISSECTION WAS COVERED WITH 2.50 X 12MM SYNERGY XD DES, AND THE PROCEDURE WAS COMPLETED. THE PATIENT WAS STABLE POST PROCEDURE AND FULLY RECOVERED.

Description of Event or Problem · 0

IT WAS REPORTED THAT A DISSECTION OCCURRED. THE PATIENT PRESENTED WITH AN INFERIOR WALL MYOCARDIAL INFARCTION. THE TARGET LESION WAS LOCATED IN THE PROXIMAL RIGHT CORONARY ARTERY. A 2.75 X 28MM SYNERGY XD DRUG-ELUTING STENT (DES) WAS DEPLOYED. POST DEPLOYMENT, A TYPE B FLOW-LIMITING DISTAL STENT EDGE DISSECTION WAS OBSERVED, WITH TIMI II FLOW NOTED. THE DISSECTION WAS COVERED WITH 2.50 X 12MM SYNERGY XD DES, AND THE PROCEDURE WAS COMPLETED. THE PATIENT WAS STABLE POST PROCEDURE AND FULLY RECOVERED. IT WAS FURTHER REPORTED THAT THE TARGET LESION WAS 90% STENOSED, MODERATELY TORTUOUS AND MODERATELY CALCIFIED.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
2304830 SYNERGY XD CORONARY DRUG-ELUTING STENT NIQ BOSTON SCIENTIFIC CORPORATION 0035525324 08714729980278

Patients

Seq Age Sex Outcome Treatment
1 74 YR Male Required Intervention