RUSCH POLYFLEX STENT KIT M00570320 7032

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 05,07 report with the FDA on 2010-03-30 for RUSCH POLYFLEX STENT KIT M00570320 7032 manufactured by Boston Scientific - Marlborough.

Event Text Entries

[1557173] Note: this report pertains to the first of two complaints that occurred during the same procedure. Refer to manufacturer report # 3005099803-2010-01527. It was reported to boston scientific corporation that two polyflex airway stents were used during an airway stent placement procedure performed on (b)(6), 2010. According to the complainant, during delivery of the first polyflex stent through the laryngoscope, the stent inadvertently deployed into the patient's esophagus. The stent did not damage the patient's esophagus and the stent was able to be retrieved with gi grasping forceps. After the first polyflex had been removed, the physician attempted to implant another polyflex. During delivery, however, the stent delivery system buckled while trying to pass through the tortuous anatomy of the vocal chords and the stent could not be deployed. It was noted that the patient's anatomy had not been predilated. The stent and its delivery system were then removed from the patient. No further action was taken and the procedure has not been rescheduled. There were no patient complications as a result of this event. The patient was reported to be fine at the conclusion of the procedure.
Patient Sequence No: 1, Text Type: D, B5


[8630766] A visual examination of the device could not be performed since the complaint device was not returned for analysis. A review of the device history record (dhr) was performed; no anomalies were noted that could be related to this complaint. A review of complaint history for the reported lot number was performed and concluded there were no other complaints reported for this lot. Based on the investigation results, the most probable root cause is operational context.
Patient Sequence No: 1, Text Type: N, H10


[19945141] The patient's exact age is unknown, however the patient was reported to be over 18 years old. The complainant was unable to provide the suspect device lot number; therefore, the device expiration and manufacture dates are unknown. The complainant indicated that the device has been disposed and will not be returned for evaluation; therefore a failure analysis of the complaint device will not be completed. If there is any further relevant information, a supplemental medwatch will be filed.
Patient Sequence No: 1, Text Type: N, H10


[20027107] Note: this report pertains to the first of two complaints that occurred during the same procedure. Refer to manufacturer report # 3005099803-2010-01527. It was reported to boston scientific corporation that two polyflex airway stents were used during an airway stent placement procedure performed on (b)(6), 2010. According to the complainant, during delivery of the first polyflex stent through the laryngoscope, the stent inadvertently deployed into the patient's esophagus. The stent did not damage the patient's esophagus and the stent was able to be retrieved with gi grasping forceps. After the first polyflex had been removed, the physician attempted to implant another polyflex. During delivery, however, the stent delivery system buckled while trying to pass through the tortuous anatomy of the vocal chords and the stent could not be deployed. It was noted that the patient's anatomy had not been predilated. The stent and its delivery system were then removed from the patient. No further action was taken and the procedure has not been rescheduled. There were no patient complications as a result of this event. The patient was reported to be fine at the conclusion of the procedure.
Patient Sequence No: 1, Text Type: D, B5


MAUDE Entry Details

Report Number3005099803-2010-01526
MDR Report Key1644587
Report Source05,07
Date Received2010-03-30
Date of Report2010-03-09
Date of Event2010-03-09
Date Mfgr Received2010-04-26
Device Manufacturer Date2010-03-02
Date Added to Maude2010-05-18
Event Key0
Report Source CodeManufacturer report
Manufacturer LinkY
Number of Patients in Event0
Adverse Event Flag3
Product Problem Flag3
Reprocessed and Reused Flag3
Health Professional3
Initial Report to FDA3
Report to FDA0
Event Location0
Manufacturer ContactMR. CHARLES MONTGOMERY
Manufacturer Street100 BOSTON SCIENTIFIC WAY
Manufacturer CityMARLBOROUGH MA 01752
Manufacturer CountryUS
Manufacturer Postal01752
Manufacturer Phone5086834000
Manufacturer G1WILLY RUESCH GMBH
Manufacturer StreetWILLY RUESCH STRASSE 4-10
Manufacturer CityKERNEN 71394
Manufacturer Postal Code71394
Single Use3
Previous Use Code3
Event Type3
Type of Report3

Device Details

Brand NameRUSCH POLYFLEX STENT KIT
Generic NamePROSTHESIS, TRACHEAL, EXPANDABLE, POLYMERIC
Product CodeNYT
Date Received2010-03-30
Model NumberM00570320
Catalog Number7032
Lot Number0000010071
Device Expiration Date2015-01-31
OperatorPHYSICIAN
Device AvailabilityN
Device AgeDA
Device Eval'ed by MfgrR
Device Sequence No1
Device Event Key0
ManufacturerBOSTON SCIENTIFIC - MARLBOROUGH
Manufacturer Address100 BOSTON SCIENTIFIC WAY MARLBOROUGH MA 01752 US 01752


Patients

Patient NumberTreatmentOutcomeDate
10 2010-03-30

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