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 2020-03-13 for PERCUFLEX NEPHROURETERAL STENT 35375 manufactured by Boston Scientific Corporation.
[183329012]
Date of event is an estimated date based off the aware date month as the exact event date was not reported.
Patient Sequence No: 1, Text Type: N, H10
[183329013]
It was reported that the stent was fractured. A 10/24 percuflex nephroureteral stent was selected for use. It was noted that the device was bent/fractured during shipping. No patient complications were reported and there was no impact on patient health as affected catheter was not used during the actual procedure.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 2134265-2020-03066 |
| MDR Report Key | 9829708 |
| Report Source | COMPANY REPRESENTATIVE,HEALTH |
| Date Received | 2020-03-13 |
| Date of Report | 2020-03-13 |
| Date of Event | 2020-02-01 |
| Date Mfgr Received | 2020-02-26 |
| Device Manufacturer Date | 2019-04-22 |
| Date Added to Maude | 2020-03-13 |
| 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 |
| Reporter Occupation | OTHER HEALTH CARE PROFESSIONAL |
| 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 DE COSTA RICA S.R.L. |
| Manufacturer Street | 2546 CALLE PRIMERA |
| Manufacturer City | ALAJUELA |
| Manufacturer Country | CS |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | PERCUFLEX NEPHROURETERAL STENT |
| Generic Name | TUBE, DRAINAGE, SUPRAPUBIC |
| Product Code | FAD |
| Date Received | 2020-03-13 |
| Model Number | 35375 |
| Catalog Number | 35375 |
| Lot Number | 0023675351 |
| 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 | 2020-03-13 |