MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a company representative,distri report with the FDA on 2020-03-26 for HT BALANCE MIDDLEWEIGHT UNIVERSAL II GUIDE WIRE 1009666J manufactured by Abbott Vascular.
[185229912]
The device is expected to be returned for investigation. It has not yet been received. A follow-up report will be submitted with all additional relevant information. Na
Patient Sequence No: 1, Text Type: N, H10
[185229913]
It was reported that the procedure was to treat an unknown lesion. Resistance was noted with the anatomy during advancement of an ht balance middleweight universal ii guide wire. The guidewire became separated into 2 pieces at the tip, while inside of the anatomy. The device was simply removed without intervention. There were no adverse patient effects and no clinically significant delay in the procedure. All significant information has been provided.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 2024168-2020-02993 |
| MDR Report Key | 9886156 |
| Report Source | COMPANY REPRESENTATIVE,DISTRI |
| Date Received | 2020-03-26 |
| Date of Report | 2020-03-26 |
| Date of Event | 2020-03-03 |
| Date Mfgr Received | 2020-03-04 |
| Device Manufacturer Date | 2019-07-15 |
| Date Added to Maude | 2020-03-26 |
| 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 | MS. LINDSEY BELL |
| Manufacturer Street | 26531 YNEZ RD. |
| Manufacturer City | TEMECULA CA 925914628 |
| Manufacturer Country | US |
| Manufacturer Postal | 925914628 |
| Manufacturer Phone | 9519143996 |
| Manufacturer G1 | ABBOTT VASCULAR, REG # 3005737652 |
| Manufacturer Street | ROAD NO.2 KM 58.0 CRUCE D |
| Manufacturer City | BARCELONETA PR 00617 |
| Manufacturer Country | US |
| Manufacturer Postal Code | 00617 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | HT BALANCE MIDDLEWEIGHT UNIVERSAL II GUIDE WIRE |
| Generic Name | GUIDE WIRE |
| Product Code | DQX |
| Date Received | 2020-03-26 |
| Model Number | 1009666J |
| Catalog Number | 1009666J |
| Lot Number | 9071571 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | Y |
| Device Eval'ed by Mfgr | R |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | ABBOTT VASCULAR |
| Manufacturer Address | 26531 YNEZ RD. TEMECULA CA 925914628 US 925914628 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2020-03-26 |