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 2019-01-08 for WALLFLEX COLONIC M00565050 6505 manufactured by Boston Scientific Corporation.
[132351941]
Patient's exact age is unknown; however it was reported that the patient was over the age of 18. (b)(4). The complainant indicated that the device was disposed and will not be returned for evaluation; therefore, a failure analysis of the complaint device could not be completed. If any further relevant information is identified, a supplemental medwatch will be filed.
Patient Sequence No: 1, Text Type: N, H10
[132351942]
It was reported to boston scientific corporation on (b)(6) 2018 that a wallflex colonic stent was to be used to treat a malignant colonic obstruction during a colonoscopy with stent placement procedure performed on (b)(6) 2018. According to the complainant, during the procedure, following stent deployment, the stent delivery system was difficult to be reconstrained. Reportedly, when the delivery system was removed from the patient the stent came out together with it. The procedure was completed with another wallflex colonic stent. There were no patient complications reported as a result of this event. The patient's condition following the procedure was reported to be stable..
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 3005099803-2018-62398 |
| MDR Report Key | 8225976 |
| Report Source | COMPANY REPRESENTATIVE,FOREIG |
| Date Received | 2019-01-08 |
| Date of Report | 2019-02-05 |
| Date of Event | 2018-12-04 |
| Date Mfgr Received | 2019-01-10 |
| Device Manufacturer Date | 2017-06-26 |
| Date Added to Maude | 2019-01-08 |
| 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 | CAROLE MORLEY |
| Manufacturer Street | 300 BOSTON SCIENTIFIC WAY |
| Manufacturer City | MARLBOROUGH MA 01752 |
| Manufacturer Country | US |
| Manufacturer Postal | 01752 |
| Manufacturer Phone | 5086834015 |
| Manufacturer G1 | BOSTON SCIENTIFIC IRELAND LIMITED |
| Manufacturer Street | BALLYBRIT BUSINESS PARK |
| Manufacturer City | GALWAY |
| Manufacturer Country | EI |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | WALLFLEX COLONIC |
| Generic Name | STENT, COLONIC, METALIC, EXPANDABLE |
| Product Code | MQR |
| Date Received | 2019-01-08 |
| Model Number | M00565050 |
| Catalog Number | 6505 |
| Lot Number | 0020789148 |
| Device Expiration Date | 2019-06-20 |
| 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 CORPORATION |
| Manufacturer Address | 300 BOSTON SCIENTIFIC WAY MARLBOROUGH MA 01752 US 01752 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2019-01-08 |