MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a company representative report with the FDA on 2017-08-25 for SPECTRANETICS ELCA CORONARY ATHERECTOMY CATHETER 114-009 manufactured by Spectranetics.
[83642336]
Patient date of birth and weight unavailable from facility.
Patient Sequence No: 1, Text Type: N, H10
[83642337]
Procedure performed to treat a lesion in the right coronary artery. An elca catheter was used for the treatment. During the procedure, a perforation occurred. It was repaired successfully, the procedure was completed, and patient survived the procedure.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 1721279-2017-00173 |
| MDR Report Key | 6820305 |
| Report Source | COMPANY REPRESENTATIVE |
| Date Received | 2017-08-25 |
| Date of Report | 2017-07-31 |
| Date of Event | 2017-05-20 |
| Date Mfgr Received | 2017-07-31 |
| Device Manufacturer Date | 2015-12-21 |
| Date Added to Maude | 2017-08-25 |
| 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 | MRS. BARBARA CREEL |
| Manufacturer Street | 9965 FEDERAL DRIVE |
| Manufacturer City | COLORADO SPRINGS CO 80921 |
| Manufacturer Country | US |
| Manufacturer Postal | 80921 |
| Manufacturer Phone | 719447-246 |
| Manufacturer G1 | SPECTRANETICS |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | SPECTRANETICS ELCA CORONARY ATHERECTOMY CATHETER |
| Generic Name | ELCA |
| Product Code | LPC |
| Date Received | 2017-08-25 |
| Model Number | 114-009 |
| Catalog Number | 114-009 |
| Lot Number | FTT15M21A |
| ID Number | NI |
| Device Expiration Date | 2017-12-23 |
| Operator | PHYSICIAN |
| Device Availability | N |
| Device Eval'ed by Mfgr | R |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | SPECTRANETICS |
| Manufacturer Address | 9965 FEDERAL DRIVE COLORADO SPRINGS CO 80921 US 80921 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Hospitalization; 2. Life Threatening; 3. Required No Informationntervention | 2017-08-25 |