FDA Adverse Event Malfunction Summary report: N

TAXUS EXPRESS2 PACLITAXEL-ELUTING CORONARY STENT SYSTEM

MDR report key: 664349 · Received January 10, 2006

Report

Report Number
6000089-2005-01921
Event Type
Malfunction
Date Received
January 10, 2006
Date of Event
October 12, 2005
Report Date
October 13, 2005
Manufacturer
BOSTON SCIENTIFIC
Product Code
NIQ
Removal / Correction Number
NA
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
KS
Reporter Occupation
PHYSICIAN

Narratives

Description of Event or Problem · 1

THIS EVENT IS NOW REPORTABLE BASED ON THE ANALYSIS COMPLETED ON 12/21/2005. IT WAS REPORTED THAT DURING A CORONARY DRUG ELUTING STENTING TREATMENT PROCEDURE, A SHAFT KINK OCCURRED. NO PATIENT INJURIES OR COMPLICATIONS WERE REPORTED. HOWEVER, THE RETURNED PRODUCT CONFIRMED THAT THERE WAS A SHAFT KINK AS WELL AS A FRACTURE OCCURRED.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1 TAXUS EXPRESS2 PACLITAXEL-ELUTING CORONARY STENT SYSTEM DRUG COATED STENT NIQ BOSTON SCIENTIFIC TAXUS EXPRESS2 8.8% 3.00 X 24 MM 7264702

Patients

Seq Age Sex Outcome Treatment
1 UNKNOWN