MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 00,02,05,07 report with the FDA on 2009-03-05 for ENTERYX PROCEDURE KIT M00572600 manufactured by Boston Scientific Corporation- Marlborough.
[1068129]
It was reported to boston scientific corporation on august 15, 2005 that an enteryx procedure kit was implanted in a patient in 2005 (patient age, gender and weight are unknown). Eight injections were performed, delivering a total of 6. 0cc's of enteryx solution to the patient. Of the total solution delivered, 2. 8cc's were injected submucosally. According to the complainant, the patient experienced bleeding from the injection site of mild intensity on the day of the procedure. The patient was treated with an injection of 8. 0cc's of epinephrine injected into the bleeding site and the bleeding had resolved before the scope was removed from the site. The patient was reported to be doing fine and no dilations were required. No weight loss was reported by the patient.
Patient Sequence No: 1, Text Type: D, B5
[8252114]
The device remains implanted in the patient; therefore, a device evaluation cannot be performed. Note: this product was removed from the global market in september 2005. Boston scientific corporation no longer produces the reported product.
Patient Sequence No: 1, Text Type: N, H10
| Report Number | 3005099803-2008-01924 |
| MDR Report Key | 1333204 |
| Report Source | 00,02,05,07 |
| Date Received | 2009-03-05 |
| Date of Report | 2005-08-15 |
| Date of Event | 2005-08-04 |
| Date Mfgr Received | 2005-08-15 |
| Device Manufacturer Date | 2004-06-24 |
| Date Added to Maude | 2009-03-05 |
| Event Key | 0 |
| Report Source Code | Manufacturer report |
| Manufacturer Link | Y |
| Number of Patients in Event | 0 |
| Adverse Event Flag | 3 |
| Product Problem Flag | 3 |
| Reprocessed and Reused Flag | 3 |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 0 |
| Event Location | 0 |
| Manufacturer Contact | KEN HIRAKAWA |
| Manufacturer Street | 100 BOSTON SCIENTIFIC WAY |
| Manufacturer City | MARLBOROUGH MA 01752 |
| Manufacturer Country | US |
| Manufacturer Postal | 01752 |
| Manufacturer Phone | 5086836264 |
| Single Use | 3 |
| Remedial Action | OT |
| Previous Use Code | 3 |
| Removal Correction Number | Z-0040-06 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | ENTERYX PROCEDURE KIT |
| Generic Name | CERAMICS, CALCIUM TRIPHOSPHATE/HYDROXYPATITE, NON-LOAD BEARING USES |
| Product Code | LMN |
| Date Received | 2009-03-05 |
| Model Number | M00572600 |
| Lot Number | 40611 |
| Device Expiration Date | 2006-10-31 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | N |
| Device Eval'ed by Mfgr | R |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | BOSTON SCIENTIFIC CORPORATION- MARLBOROUGH |
| Manufacturer Address | 100 BOSTON SCIENTIFIC WAY MARLBOROUGH MA 01752 US 01752 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Required No Informationntervention | 2009-03-05 |