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 2018-07-27 for CATHETER, TRANSLUMINAL BALLOON M00553200 5320 manufactured by Boston Scientific - Marlborough.
[115362646]
Patient's exact age is unknown; however it was reported that the patient was over the age of 18. The complainant was unable to provide the serial number. Therefore, the manufacture date is unknown. (b)(4). According to the complainant, the suspect device has been disposed and is not available for return. If any further relevant information is received, a supplemental mdr will be filed. (b)(4).
Patient Sequence No: 1, Text Type: N, H10
[115362647]
It was reported to boston scientific corporation that a pneumatic inflator was used during a gastroscopy dilation procedure performed in the esophagus on (b)(6) 2018. According to the complainant, during the procedure, when the balloon was inflated, the gauge needle did not move and appeared to be sitting loosely within the gauge. Reportedly, the balloon was able to be inflated; however, the physician was not able to confirm at what pressure it was inflated. The procedure was completed with this device. There were no patient complications reported as a result of this event. The patient's condition at the conclusion of the procedure was reported to be stable.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 3005099803-2018-02254 |
| MDR Report Key | 7728513 |
| Report Source | COMPANY REPRESENTATIVE,FOREIG |
| Date Received | 2018-07-27 |
| Date of Report | 2018-07-03 |
| Date of Event | 2018-07-03 |
| Date Mfgr Received | 2018-07-03 |
| Date Added to Maude | 2018-07-27 |
| 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 | EMP. NANCY CUTINO |
| Manufacturer Street | 100 BOSTON SCIENTIFIC WAY |
| Manufacturer City | MARLBOROUGH MA 01752 |
| Manufacturer Country | US |
| Manufacturer Postal | 01752 |
| Manufacturer Phone | 5086834000 |
| Manufacturer G1 | GLENS FALLS |
| Manufacturer Street | 10 GLENS FALLS TECHNICAL PARK |
| Manufacturer City | GLENS FALLS NY 12801 |
| Manufacturer Country | US |
| Manufacturer Postal Code | 12801 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | CATHETER, TRANSLUMINAL BALLOON |
| Generic Name | CATHETER, BALLOON TYPE |
| Product Code | GBA |
| Date Received | 2018-07-27 |
| Model Number | M00553200 |
| Catalog Number | 5320 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | N |
| Device Eval'ed by Mfgr | R |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | BOSTON SCIENTIFIC - MARLBOROUGH |
| Manufacturer Address | 100 BOSTON SCIENTIFIC WAY MARLBOROUGH MA 01752 US 01752 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2018-07-27 |