MAUDE MDR 9890973

MDR report key
9890973
Report number
2024168-2020-03045
Event key
0
Event type
3
Date of event
2020-02-13
Date received
2020-03-27
Adverse event
3
Product problem
3
Patients in event
0
Reporter occupation
1
Health professional
3
Initial report to FDA
3
Event location
3

Manufacturer Contact#

Contact
MS. LINDSEY BELL
Address
26531 YNEZ RD. TEMECULA CA 92591 US
Phone
951-951-9519
Report source
M
Manufacturer link flag
Y

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1SUPERA PERIPHERAL STENT SYSTEMSELF EXPANDING PERIPHERAL STENT SYSTEMABBOTT VASCULARNIP42065100-1209081261R N

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12020-03-270

Event Narratives#

N

Patient 1

THE DEVICE WAS NOT RETURNED FOR EVALUATION. A REVIEW OF THE LOT HISTORY RECORD IDENTIFIED NO MANUFACTURING NONCONFORMITIES ISSUED TO THE REPORTED LOT THAT WOULD HAVE CONTRIBUTED TO THIS EVENT. ADDITIONALLY, A REVIEW OF THE COMPLAINT HISTORY IDENTIFIED NO OTHER SIMILAR INCIDENTS AND/OR COMPLAINTS FROM THIS LOT. BASED ON THE INFORMATION PROVIDED, A DEFINITIVE CAUSE FOR THE DIFFICULTIES COULD NOT BE DETERMINED. IT MAY BE POSSIBLE THAT THE VESSEL DIAMETER WAS NARROWED IN SOME LOCATIONS CAUSING THE STENTS TO ELONGATE DURING DEPLOYMENT; HOWEVER, THIS COULD NOT BE CONFIRMED. THERE IS NO INDICATION OF A PRODUCT QUALITY ISSUE WITH RESPECT TO THE DESIGN, MANUFACTURE, OR LABELING OF THE DEVICE. THE ADDITIONAL SUPERA DEVICE REFERENCED IS BEING FILED UNDER A SEPARATE MEDWATCH REPORT.

D

Patient 1

IT WAS REPORTED THAT THE PROCEDURE WAS PERFORMED TO TREAT A LESION IN THE POPLITEAL ARTERY AND FEMORAL ARTERY. FOLLOWING PRE-DILATATION, A 6.5X200MM SUPERA SELF-EXPANDING STENT (SES) WAS DEPLOYED IN THE POPLITEAL ARTERY AND 6.5X100MM SUPERA SES WERE DEPLOYED IN THE FEMORAL ARTERY; HOWEVER, THEY SEEMED TO BE LONGER THAN THE SIZE ON THE LABEL. THE 6.5X200MM SES MEASURES AROUND 300MM POST-DEPLOYMENT AND THE 6.5X100MM SES MEASURES AROUND 180MM POST-DEPLOYMENT, BOTH STENTS ELONGATED MORE THAN 10%. BOTH SESS WERE REMOVED UNDER FLUOROSCOPY. THE PROCEDURE WAS SUCCESSFULLY COMPLETED WITH NO CONSEQUENCE TO THE PATIENT. THERE WAS NO CLINICALLY SIGNIFICANT DELAY IN THE PROCEDURE. NO ADDITIONAL INFORMATION WAS PROVIDED.