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 2020-03-30 for SYNERGY 10607 manufactured by Boston Scientific Corporation.
[185674936]
Device is a combination product.
Patient Sequence No: 1, Text Type: N, H10
[185674937]
It was reported that stent damage occurred. The target lesion was located in the tortuous right coronary artery. After engaging a 6f mach 1ar1 guide catheter and advancing a samurai wire, a 4. 00x38mm synergy ii stent was advanced to treat the lesion. However, the device could not advanced and the stent struts were damaged. Dilatation was performed with a 4. 0x20mm nc quantum balloon and a choice pt buddy wire was placed. The procedure was completed with another 4. 00x38mm synergy stent. No patient complications were reported and the patient's status was stable.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 2134265-2020-04071 |
| MDR Report Key | 9898383 |
| Report Source | COMPANY REPRESENTATIVE,HEALTH |
| Date Received | 2020-03-30 |
| Date of Report | 2020-03-30 |
| Date of Event | 2020-03-17 |
| Date Mfgr Received | 2020-03-17 |
| Device Manufacturer Date | 2019-10-16 |
| Date Added to Maude | 2020-03-30 |
| 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 CORPORATION |
| Manufacturer Street | BALLYBRIT BUSINESS PARK |
| Manufacturer City | GALWAY |
| Manufacturer Country | EI |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | SYNERGY |
| Generic Name | BIODEGRADABLE POLYMER DRUG ELUTING CORONARY STENT SYSTEM |
| Product Code | NIQ |
| Date Received | 2020-03-30 |
| Model Number | 10607 |
| Catalog Number | 10607 |
| Lot Number | 0024676301 |
| 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 | 2020-03-30 |