MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a company representative,foreig report with the FDA on 2017-05-16 for MICROPLEX VFC FILL COIL VFC030610-V-A manufactured by Microvention, Inc..
[75325447]
The lot number was provided. A review of the approved device history records indicated the lot met all release criteria. A lot history trending review was performed and there were no similar complaints for this lot number. The device has not yet been returned for evaluation. The investigation is currently underway. The device was used during the same procedure as was reported in mfr. Report# 2032493-2017-00116.
Patient Sequence No: 1, Text Type: N, H10
[75325448]
It was reported that while repositioning an embolization coil in a ruptured aneurysm, the coil stretched and then detached in the microcatheter. Both segments of the coil were removed together with the microcatheter from the patient. There was no reported patient injury. The patient's current status is reported to be good.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 2032493-2017-00117 |
| MDR Report Key | 6571489 |
| Report Source | COMPANY REPRESENTATIVE,FOREIG |
| Date Received | 2017-05-16 |
| Date of Report | 2017-04-17 |
| Date of Event | 2017-04-17 |
| Date Mfgr Received | 2017-04-17 |
| Device Manufacturer Date | 2015-12-02 |
| Date Added to Maude | 2017-05-16 |
| 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 | 3 |
| Event Location | 3 |
| Manufacturer Contact | MS. DEBBY CALLAHAN |
| Manufacturer Street | 1311 VALENCIA AVENUE |
| Manufacturer City | TUSTIN CA 92780 |
| Manufacturer Country | US |
| Manufacturer Postal | 92780 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | MICROPLEX VFC FILL COIL |
| Generic Name | EMBOLIZATION COIL |
| Product Code | HGC |
| Date Received | 2017-05-16 |
| Model Number | VFC030610-V-A |
| Lot Number | 151202VC2 |
| Operator | PHYSICIAN |
| Device Availability | Y |
| Device Age | DA |
| Device Eval'ed by Mfgr | Y |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | MICROVENTION, INC. |
| Manufacturer Address | 1311 VALENCIA AVENUE TUSTIN CA 92780 US 92780 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2017-05-16 |