MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a company representative,health report with the FDA on 2020-01-08 for VICI 26930 manufactured by Veniti, Inc..
[174306792]
Date of event: unknown, (b)(6) 2019 is an estimation based on information received.
Patient Sequence No: 1, Text Type: N, H10
[174306793]
It was reported that the stent fractured, requiring additional intervention. The physician stated that he had done a previous iliac vein stent procedure using an unknown vici self expanding stent a couple months prior. The patient was brought back and it was noted that the vici stent had fractured. The physician re-stented the area with unknown sized wallstents to fix the issue. There were no patient complications reported. The procedure was a success and the patient was doing well post procedure.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 2134265-2020-00013 |
| MDR Report Key | 9565566 |
| Report Source | COMPANY REPRESENTATIVE,HEALTH |
| Date Received | 2020-01-08 |
| Date of Report | 2020-02-11 |
| Date of Event | 2019-10-01 |
| Date Mfgr Received | 2020-02-10 |
| Date Added to Maude | 2020-01-08 |
| 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 | JAY JOHNSON |
| Manufacturer Street | TWO SCIMED PLACE |
| Manufacturer City | MAPLE GROVE MN 55311 |
| Manufacturer Country | US |
| Manufacturer Postal | 55311 |
| Manufacturer Phone | 7634942574 |
| Manufacturer G1 | VENITI, INC. |
| Manufacturer Street | 4025 CLIPPER COURT |
| Manufacturer City | FREMONT CA 94538 |
| Manufacturer Country | US |
| Manufacturer Postal Code | 94538 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | VICI |
| Product Code | QAN |
| Date Received | 2020-01-08 |
| Model Number | 26930 |
| Catalog Number | 26930 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | N |
| Device Age | DA |
| Device Eval'ed by Mfgr | R |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | VENITI, INC. |
| Manufacturer Address | 4025 CLIPPER COURT FREMONT CA 94538 US 94538 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Required No Informationntervention | 2020-01-08 |