BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    PROMUS ELEMENT ?

    MDR report key: 3822502 · Received May 21, 2014

    Report

    Report Number
    2134265-2014-02718
    Event Type
    Malfunction
    Date Received
    May 21, 2014
    Date of Event
    April 1, 2014
    Report Date
    April 22, 2014
    Manufacturer
    BOSTON SCIENTIFIC - GALWAY
    Product Code
    NIQ
    PMA / PMN Number
    SIMILAR
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CN
    Reporter Occupation
    PHYSICIAN

    Narratives

    Additional Manufacturer Narrative · 1

    DEVICE EVALUATED BY MFR.: A VISUAL EXAMINATION OF THE CRIMPED STENT FOUND STENT STRUTS ON THE PROXIMAL END OF THE CRIMPED STENT WERE DISTORTED AND LIFTED UPWARDS FROM THE STENT PROFILE. THE BUMPER TIP OF THE DEVICE SHOWED NO SIGNS OF DAMAGE. THE BALLOON CONES PROFILES WERE REVIEWED AND NO ISSUES WERE NOTED WITH THE OVERALL BALLOON PROFILE. THE BALLOON WINGS WERE TIGHTLY WRAPPED AND EVENLY FOLDED AND WERE NOT SUBJECTED TO POSITIVE PRESSURE. A VISUAL AND TACTILE EXAMINATION FOUND MULTIPLE KINKS ALONG THE HYPOTUBE SHAFT. A VISUAL AND TACTILE EXAMINATION FOUND NO ISSUES WITH THE PROFILE. 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).

    Additional Manufacturer Narrative · 1

    DEVICE IS A COMBINATION PRODUCT. (B)(4).

    Description of Event or Problem · 1

    IT WAS REPORTED THAT STENT DAMAGE OCCURRED. THE 85% STENOSED CONCENTRIC, DE NOVO, 14X2.75MM TARGET LESION CONTAINED >45 AND <90 DEGREE BEND AND WAS LOCATED IN A MODERATELY TORTUOUS AND MODERATELY CALCIFIED LEFT CIRCUMFLEX (LCX) ARTERY. FOLLOWING PREDILATION, A 2.75X16MM PROMUS ELEMENT ¿ DRUG-ELUTING STENT WAS SELECTED FOR USE AND ADVANCED TO TREAT THE TARGET LESION. HOWEVER, WHEN THE STENT CROSSED THE LESION THE STENT BODY WAS NOTED TO HAVE LIFTED. THE PROCEDURE WAS COMPLETED WITH ANOTHER OF THE SAME DEVICE. NO PATIENT COMPLICATIONS WERE REPORTED AND THE PATIENT STATUS WAS STABLE.

    Description of Event or Problem · 1

    IT WAS REPORTED THAT STENT DAMAGE OCCURRED. THE 85% STENOSED CONCENTRIC, DE NOVO, 14X2.75MM TARGET LESION CONTAINED >45 AND <90 DEGREE BEND AND WAS LOCATED IN A MODERATELY TORTUOUS AND MODERATELY CALCIFIED LEFT CIRCUMFLEX (LCX) ARTERY. FOLLOWING PREDILATION, A 2.75X16MM PROMUS ELEMENT ¿ DRUG-ELUTING STENT WAS SELECTED FOR USE AND ADVANCED TO TREAT THE TARGET LESION. HOWEVER, WHEN THE STENT CROSSED THE LESION THE STENT BODY WAS NOTED TO HAVE LIFTED. THE PROCEDURE WAS COMPLETED WITH ANOTHER OF THE SAME DEVICE. NO PATIENT COMPLICATIONS WERE REPORTED AND THE PATIENT STATUS WAS STABLE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    303763 PROMUS ELEMENT ? STENT, CORONARY, DRUG-ELUTING NIQ BOSTON SCIENTIFIC - GALWAY H7493911316270 0016115250

    Patients

    Seq Age Sex Outcome Treatment
    1 56 YR