MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 1993-01-13 for SCI MED 9267RC 01878-09 manufactured by Sci-med Life Systems.
[2311]
Incident 1: balloon dilatation catheter burst during procedure exchanged balloon without incident. Incident 2: balloon catheter burst during procedure no exchange was made - artery dilated without incidentdevice labeled for single use. Patient medical status prior to event: satisfactory condition. There was not multiple patient involvement. Invalid data - on device service/maintenance. No data - regarding date last serviced. Service provided by: invalid data. Invalid data - service records availability. Imminent hazard to public health claimed. Device used as labeled/intended. Device was not evaluated after the event. Method of evaluation: no data. Results of evaluation: no data. Conclusion: no data. Certainty of device as cause of or contributor to event: yes. Corrective actions: device returned to manufacturer/dealer/distributor, other. The device was not destroyed/disposed of.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 3779 |
| MDR Report Key | 3779 |
| Date Received | 1993-01-13 |
| Date of Report | 1992-10-09 |
| Date of Event | 1992-09-04 |
| Date Facility Aware | 1992-09-04 |
| Report Date | 1992-10-09 |
| Date Reported to FDA | 1992-10-09 |
| Date Reported to Mfgr | 1992-09-20 |
| Date Added to Maude | 1993-05-05 |
| Event Key | 0 |
| Report Source Code | User Facility report |
| Manufacturer Link | N |
| Number of Patients in Event | 0 |
| Adverse Event Flag | 3 |
| Product Problem Flag | 3 |
| Reprocessed and Reused Flag | 0 |
| Health Professional | 0 |
| Initial Report to FDA | 0 |
| Report to FDA | 3 |
| Event Location | 3 |
| Single Use | 0 |
| Previous Use Code | 0 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | SCI MED |
| Generic Name | LONG SKINNY 3.0 MM |
| Product Code | GCC |
| Date Received | 1993-01-13 |
| Model Number | 9267RC |
| Catalog Number | 01878-09 |
| Lot Number | 306423 |
| ID Number | N/A |
| Operator | OTHER HEALTH CARE PROFESSIONAL |
| Device Availability | N |
| Implant Flag | N |
| Device Sequence No | 1 |
| Device Event Key | 3523 |
| Manufacturer | SCI-MED LIFE SYSTEMS |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Other | 1993-01-13 |