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 2019-12-16 for VASCUTRAK PTA DILATATION CATHETER V1850150 manufactured by Bard Peripheral Vascular, Inc..
[174531912]
As the lot number for the device was provided, a manufacturing review will be performed. The sample was not returned to the manufacturer for inspection/evaluation. Therefore, the investigation of the reported event is inconclusive. Based upon the available information, the definitive root cause for this event is unknown. The instructions for use (ifu) is adequate for the reported device/patient codes and provides general instructions for use, as well as warnings, precautions and potential complications associated with the device. Upon receipt of new or additional information, a follow-up report will be submitted as applicable. (expiry date: 02/2022).
Patient Sequence No: 1, Text Type: N, H10
[174531913]
It was reported that during an angioplasty procedure of a slightly calcified lesion in the popliteal artery, the pta balloon allegedly would not deflate. It was further reported that the physician used a needle stick to percutaneously deflate the balloon. A stent was placed at the puncture site. Patency was reportedly restored post procedure. There were no further reported complications.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 2020394-2019-05632 |
| MDR Report Key | 9477166 |
| Report Source | COMPANY REPRESENTATIVE,FOREIG |
| Date Received | 2019-12-16 |
| Date of Report | 2020-03-02 |
| Date of Event | 2019-11-19 |
| Date Mfgr Received | 2020-02-28 |
| Date Added to Maude | 2019-12-16 |
| 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 | JUDITH LUDWIG |
| Manufacturer Street | 1415 W. 3RD STREET |
| Manufacturer City | TEMPE AZ 85281 |
| Manufacturer Country | US |
| Manufacturer Postal | 85281 |
| Manufacturer Phone | 4803032689 |
| Manufacturer G1 | C.R. BARD, INC. (GFO) |
| Manufacturer Street | 289 BAY ROAD |
| Manufacturer City | QUEENSBURY NY 12804 |
| Manufacturer Country | US |
| Manufacturer Postal Code | 12804 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | VASCUTRAK PTA DILATATION CATHETER |
| Generic Name | PTA BALLOON DILATATION CATHETER |
| Product Code | PNO |
| Date Received | 2019-12-16 |
| Returned To Mfg | 2020-01-03 |
| Model Number | V1850150 |
| Catalog Number | V1850150 |
| Lot Number | GFDP3791 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | R |
| Device Age | DA |
| Device Eval'ed by Mfgr | Y |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | BARD PERIPHERAL VASCULAR, INC. |
| Manufacturer Address | 1625 W 3RD ST. TEMPE AZ 85281 US 85281 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Required No Informationntervention | 2019-12-16 |