FDA Adverse Event Malfunction Summary report: N

PTCA CATHTERS

MDR report key: 788945 · Received November 17, 2006

Report

Report Number
6000093-2006-02381
Event Type
Malfunction
Date Received
November 17, 2006
Report Date
October 19, 2006
Manufacturer
BOSTON SCIENTIFIC CORP.
Product Code
LOX
PMA / PMN Number
P860019 S201
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
NC, US
Reporter Occupation
PHYSICIAN

Narratives

Additional Manufacturer Narrative · 1

RETURNED PRODUCT ANALYSIS VERIFIED THE DIFFICULTY AS STATED IN THE COMPLAINT. THE BALLOON CATHETER WITH THE BALLOON IN A DEFLATED STATE WAS REC'D IN GOOD CONDITION WITH NO DAMAGE OBSERVED. VISUAL AND MICROSCOPIC EXAMINATION OF THE MATERIAL REVEALED A TEAR IN THE BALLOON WALL LOCATED 6 MILLIMETERS PROXIMALLY FROM THE DISTAL TIP. EXAMINATION OF THE AREA SURROUNDING THE TEAR DID NOT REVEAL ANY IRREGULARITIES IN THE BALLOON MATERIAL WHICH WOULD HAVE CONTRIBUTED TO THE FORMATION OF THE TEAR. NO ISSUES WERE NOTED WITH THE BALLOON MATERIAL OR THE RO MARKERS THAT COULD HAVE CONTRIBUTED TO THE LEAK. THE MANUFACTURING RECORDS FOR TOP ASSEMLY BATCH 8925607 HAVE BEEN REVIEWED AND NO ISSUES OR DISCREPANCIES WERE FOUND. THIS RECORDS REVIEW CONFIRMS THAT THE DEVICE MET ALL MATERIAL, ASSEMBLY, AND PERFORMANCE SPECIFICATIONS. THERE ARE NO SIMILAR COMPLAINTS OF THIS NATURE RELATED TO THIS BATCH NUMBER. THE ROOT CAUSE OF THE TEAR COULD NOT BE DETERMINED.

Description of Event or Problem · 1

IT WAS REPORTED THAT DURING AN UNSPECIFIED TREATMENT PROCEDURE, THE MAVERICK2 MONORAIL BALLOON RUPTURED. THE LESION BEING TREATED IS UNKNOWN. ACCORDING TO THE CUSTOMER, "BALLOON RUPTURE ON INITIAL INFLATION AT 8 ATMS." THE PT CONDITION IS UNKNOWN. ADDITIONAL INFORMATION HAS BEEN REQUESTED.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1 PTCA CATHTERS LOX-CATHETERS, TRANSLUMINAL CORONARY ANGIOPLASTY, PERCUTANEO LOX BOSTON SCIENTIFIC CORP. MAVERICK2 8925607

Patients

Seq Age Sex Outcome Treatment
1 UNKNOWN