MAUDE MDR 3601524

MDR report key
3601524
Report number
3008853977-2014-00034
Event key
0
Event type
3
Date of event
2014-01-14
Date received
2014-01-31
Adverse event
3
Product problem
3
Patients in event
0
Reporter occupation
1
Health professional
3
Initial report to FDA
3
Event location
0

Manufacturer Contact#

Contact
MR. ALYSON HARRIS
Address
47900 BAYSIDE PARKWAY FREMONT CA 94538 US
Phone
510-510-5104
Report source
M
Manufacturer link flag
Y

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1FG GATEWAY OTW OUS 2.00MM X 15MMCATHETER, BALLOON TYPEBOSTON SCIENTIFIC - MINNPAVM003207241520016177380R N

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12014-01-3101. D

Event Narratives#

D

Patient 1

IT WAS REPORTED THAT A PATIENT PRESENTED WITH 72% STENOSIS IN THE RIGHT M1 MIDDLE CEREBRAL ARTERY (MCA). THE SUBJECT DEVICE WAS ADVANCED INTO THE STENOSED LESION AND INFLATED TO 6 ATM. THE DEVICE WAS REMOVED AND THE STENOSIS WAS NOT IMPROVED. THE DEVICE WAS READVANCED AND REINFLATED TO 8 ATM. THE STENOSIS SEEMED TO BE IMPROVED UNDER ANGIOGRAPHY AND THE DEVICE WAS REMOVED. HOWEVER, THE CT-SCAN SHOWED A HEMORRHAGE. THE HEMORRHAGE RESULTED IN A STROKE. THE PATIENT WAS TREATED WITH ASPIRIN, LIPITOR AND LIUSUANQINGLUPIGELEI PIAN. ONE DAY POST PROCEDURE THE PATIENT PASSED AWAY.

N

Patient 1

DEVICE WAS DISPOSED.

D

Patient 1

IT WAS REPORTED THAT A PATIENT PRESENTED WITH 72% STENOSIS IN THE RIGHT M1 MIDDLE CEREBRAL ARTERY (MCA). THE SUBJECT DEVICE WAS ADVANCED INTO THE STENOSED LESION AND INFLATED TO 6 ATM. THE DEVICE WAS REMOVED AND THE STENOSIS WAS NOT IMPROVED. THE DEVICE WAS READVANCED AND REINFLATED TO 8 ATM. THE STENOSIS SEEMED TO BE IMPROVED UNDER ANGIOGRAPHY AND THE DEVICE WAS REMOVED. HOWEVER, THE CT-SCAN SHOWED A HEMORRHAGE. THE HEMORRHAGE RESULTED IN A STROKE. THE PATIENT WAS TREATED WITH ASPIRIN, LIPITOR AND LIUSUANQINGLUPIGELEI PIAN. ONE DAY POST PROCEDURE THE PATIENT PASSED AWAY.

N

Patient 1

THE DEVICE HISTORY RECORD REVIEW CONFIRMS THAT THE DEVICE MET ALL MATERIAL, ASSEMBLY AND PERFORMANCE SPECIFICATIONS. THE DEVICE WAS NOT RETURNED; THEREFORE, ANALYSIS CANNOT BE PERFORMED. FROM THE INFORMATION PROVIDED THERE WAS NO INDICATION THAT THE DEVICE WAS NOT USED AS IN ACCORDANCE WITH THE LABELING OR THAT THIS CAUSED OR CONTRIBUTED TO THE REPORTED EVENT. PATIENT HEMORRHAGE, STROKE AND DEATH ARE KNOWN AND ANTICIPATED COMPLICATIONS TO THESE TYPES OF PROCEDURES AND ARE NOTED IN THE LABELING. THEREFORE, IT WAS DETERMINED THAT THE REPORTED EVENT WAS AN ANTICIPATED PROCEDURAL COMPLICATION.