MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a health professional report with the FDA on 2019-01-03 for FG GATEWAY OTW JP 2.50MM X 12MM M0032072012250 manufactured by Boston Scientific - Minn.
[132061029]
The subject device is not available.
Patient Sequence No: 1, Text Type: N, H10
[132061030]
It was reported that during the test inflation of balloon with 50% of contrast media inside the vessel of the body (close to operation site), balloon could not be inflated. Balloon was removed outside of the body to attempt preparation with normal saline but burst of the balloon was confirmed. The procedure was completed successfully using other device. No conical consequences were reported due to the event.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 3008853977-2019-00003 |
| MDR Report Key | 8215627 |
| Report Source | HEALTH PROFESSIONAL |
| Date Received | 2019-01-03 |
| Date of Report | 2019-01-15 |
| Date of Event | 2018-12-19 |
| Date Mfgr Received | 2019-01-15 |
| Device Manufacturer Date | 2017-06-29 |
| Date Added to Maude | 2019-01-03 |
| 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 | MR. TARA LOPEZ |
| Manufacturer Street | 47900 BAYSIDE PARKWAY |
| Manufacturer City | FREMONT CA 94538 |
| Manufacturer Country | US |
| Manufacturer Postal | 94538 |
| Manufacturer Phone | 5104132500 |
| Manufacturer G1 | BOSTON SCIENTIFIC - MINN |
| Manufacturer Street | ONE SCIMED PLACE |
| Manufacturer City | MAPLE GROVE MN 55311 |
| Manufacturer Country | US |
| Manufacturer Postal Code | 55311 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | FG GATEWAY OTW JP 2.50MM X 12MM |
| Generic Name | CATHETER, BALLOON TYPE |
| Product Code | GBA |
| Date Received | 2019-01-03 |
| Catalog Number | M0032072012250 |
| Lot Number | 20771985 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | N |
| Device Age | DA |
| Device Eval'ed by Mfgr | R |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | BOSTON SCIENTIFIC - MINN |
| Manufacturer Address | ONE SCIMED PLACE MAPLE GROVE MN 55311 US 55311 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2019-01-03 |