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 2020-03-06 for JETSTREAM XC ATHERECTOMY CATHETER 45007 manufactured by Boston Scientific Corporation.
[182428687]
It was reported that the device became entrapped on the guidewire a 2. 4mm jetstream xc atherectomy catheter and a non-bsc guidewire were selected for use in the superficial femoral artery (sfa). During the procedure, the device was activated for around 4 minutes and then the device became entrapped on the wire. The catheter and guidewire were removed together as one unit. The procedure was completed by dilation only without further atherectomy. There were no patient complications and the patient was stable post procedure.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 2134265-2020-02641 |
| MDR Report Key | 9800114 |
| Report Source | COMPANY REPRESENTATIVE,FOREIG |
| Date Received | 2020-03-06 |
| Date of Report | 2020-03-06 |
| Date of Event | 2020-02-26 |
| Date Mfgr Received | 2020-02-27 |
| Device Manufacturer Date | 2019-12-04 |
| Date Added to Maude | 2020-03-06 |
| 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 CORK LIMITED |
| Manufacturer Street | MODEL FARM ROAD |
| Manufacturer City | CORK |
| Manufacturer Country | EI |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | JETSTREAM XC ATHERECTOMY CATHETER |
| Generic Name | CATHETER, PERIPHERAL, ATHERECTOMY |
| Product Code | MCW |
| Date Received | 2020-03-06 |
| Model Number | 45007 |
| Catalog Number | 45007 |
| Lot Number | 0024871077 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | N |
| Device Eval'ed by Mfgr | R |
| 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 | 2020-03-06 |