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 2020-02-14 for ACCUSTICK II 35615 manufactured by Boston Scientific Corporation.
[180124372]
It was reported that a tip fracture occurred. The target lesion was located in the liver. An accustick ii was selected for use in a percutaneous transhepatic biliary drainage (ptbd). During preparation, it was noted that the tip was broken. The procedure was completed with another of the same device. No patient complications were reported.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 2134265-2020-01545 |
| MDR Report Key | 9711278 |
| Report Source | COMPANY REPRESENTATIVE,FOREIG |
| Date Received | 2020-02-14 |
| Date of Report | 2020-03-31 |
| Date of Event | 2020-02-03 |
| Date Mfgr Received | 2020-03-24 |
| Device Manufacturer Date | 2018-03-12 |
| Date Added to Maude | 2020-02-14 |
| 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 | BOSTON SCIENTIFIC CORPORATION |
| Manufacturer Street | 780 BROOKSIDE DRIVE |
| Manufacturer City | SPENCER IN 47460 |
| Manufacturer Country | US |
| Manufacturer Postal Code | 47460 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | ACCUSTICK II |
| Generic Name | INTRODUCER, CATHETER |
| Product Code | KGZ |
| Date Received | 2020-02-14 |
| Returned To Mfg | 2020-02-25 |
| Model Number | 35615 |
| Catalog Number | 35615 |
| Lot Number | 0021847582 |
| 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 | TWO SCIMED PLACE MAPLE GROVE MN 55311 US 55311 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2020-02-14 |