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 2020-01-03 for AXIOS STENT AND DELIVERY SYSTEM M00553560 5356 manufactured by Boston Scientific Corporation.
[174870617]
Patient's exact age is unknown; however it was reported that the patient was over the age of 18. (b)(4). Although expected, the device has not been received for analysis. Upon receipt and completion of the failure analysis of the complaint device, if there is any further relevant information from that review, a supplemental mdr will be filed.
Patient Sequence No: 1, Text Type: N, H10
[174870618]
It was reported to boston scientific corporation that a hot axios stent was to be implanted transgastric to the stomach during an endoscopic ultrasound (eus) directed transgastric ercp (edge) procedure performed on (b)(6) 2019. Reportedly, the patient had a previous stomach bypass, and the stent was being used for anastomosis between the two stomach walls. According to the complainant, during the procedure, after the first flange was deployed, the stent lock failed to lock, and the second flange of the stent prematurely deployed. The stent was unable to be repositioned to the correct position. The stent was removed from the patient using forceps, and a second hot axios stent was placed to complete the procedure. 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 ok and stable. Note: the stent was being implanted transgastric to the stomach during an endoscopic ultrasound (eus) directed transgastric ercp (edge) procedure; however, the hot axios stent and delivery system is indicated for use to facilitate transgastric or transduodenal endoscopic drainage of a pancreatic pseudocyst or the biliary tract.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 3005099803-2019-06367 |
| MDR Report Key | 9549263 |
| Report Source | COMPANY REPRESENTATIVE,FOREIG |
| Date Received | 2020-01-03 |
| Date of Report | 2020-02-11 |
| Date of Event | 2019-12-04 |
| Date Mfgr Received | 2020-01-14 |
| Device Manufacturer Date | 2019-09-11 |
| Date Added to Maude | 2020-01-03 |
| 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 | 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 CORPORATION |
| 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 | AXIOS STENT AND DELIVERY SYSTEM |
| Generic Name | PANCREATIC STENT, COVERED, METALLIC, REMOVABLE |
| Product Code | PCU |
| Date Received | 2020-01-03 |
| Returned To Mfg | 2020-01-09 |
| Model Number | M00553560 |
| Catalog Number | 5356 |
| Lot Number | 0024412676 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | R |
| Device Age | DA |
| Device Eval'ed by Mfgr | Y |
| 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 | 1. Required No Informationntervention | 2020-01-03 |