MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a foreign,study report with the FDA on 2020-03-23 for STELLAREX 0.035 OTW DRUG-COATED ANGIOPLASTY BALLOON A35SX050120135 manufactured by Spectranetics.
[184614738]
The patient's cause of death was unrelated to the study device or procedure. This is being reported as a follow-up to the clinical study. Cross reference mfr report numbers: 3009784280-2020-00077. Report source: foreign- (b)(6)/ study name: (b)(6)- patient id #(b)(6). Pma/510k: pma number is not applicable. The device is a non-commercial product with a ce mark that was used as part of a clinical study. During the index procedure, the product worked as intended and the device was discarded, thus no product evaluation was performed. Per the ifu, death is listed as a potential complications/adverse events.
Patient Sequence No: 1, Text Type: N, H10
[184614739]
It was reported through a clinical study that during the index procedure on (b)(6) 2016, two stellarex catheters were used to treat the target lesion of the right mid and distal sfa. Approximately 38 months post index procedure, the patient expired due to complications of sepsis, alzheimer, and acute kidney insufficiency on (b)(6) 2019. The physician indicated this is not related to the study device or procedure.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 3009784280-2020-00076 |
| MDR Report Key | 9869366 |
| Report Source | FOREIGN,STUDY |
| Date Received | 2020-03-23 |
| Date of Report | 2020-03-11 |
| Date of Event | 2016-09-05 |
| Report Date | 2005-01-01 |
| Date Reported to FDA | 2005-01-01 |
| Date Reported to Mfgr | 2005-01-10 |
| Date Mfgr Received | 2020-03-11 |
| Date Added to Maude | 2020-03-23 |
| Event Key | 0 |
| Report Source Code | Manufacturer report |
| Manufacturer Link | Y |
| Number of Patients in Event | 0 |
| Adverse Event Flag | 3 |
| Product Problem Flag | 0 |
| Reprocessed and Reused Flag | 3 |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 3 |
| Event Location | 3 |
| Manufacturer Contact | MS. ANA TAN |
| Manufacturer Street | 5055 BRANDIN COURT |
| Manufacturer City | FREMONT CA 94538 |
| Manufacturer Country | US |
| Manufacturer Postal | 94538 |
| Manufacturer Phone | 510933-798 |
| Manufacturer G1 | SPECTRANETICS |
| Manufacturer Street | 6531 DUMBARTON CIRCLE |
| Manufacturer City | FREMONT CA 94555 |
| Manufacturer Country | US |
| Manufacturer Postal Code | 94555 |
| Single Use | 0 |
| Previous Use Code | 0 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | STELLAREX 0.035 OTW DRUG-COATED ANGIOPLASTY BALLOON |
| Generic Name | DCB PTA CATHETER |
| Product Code | ONU |
| Date Received | 2020-03-23 |
| Model Number | A35SX050120135 |
| Catalog Number | A35SX050120135 |
| Lot Number | FXX16G20A |
| Device Expiration Date | 2018-07-29 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | N |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | SPECTRANETICS |
| Manufacturer Address | 6531 DUMBARTON CIRCLE FREMONT CA 94555 US 94555 |
| Brand Name | PACLITAXEL, 2 ?G/MM2 |
| Product Code | --- |
| Date Received | 2020-03-23 |
| Device Sequence No | 101 |
| Device Event Key | 0 |
| Manufacturer | SPECTRANETICS |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Other | 2020-03-23 |