MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a company representative,foreig report with the FDA on 2020-03-31 for 2CM PERIPHERAL CUTTING BALLOON 24628 manufactured by Boston Scientific Corporation.
[185944168]
(b)(6).
Patient Sequence No: 1, Text Type: N, H10
[185944169]
It was reported that a blade was missing. The 75% stenosed target lesion was located in the moderately tortuous cephalic vein. A 6. 00mm/ 2. 0cm/ 50cm peripheral cutting balloon was selected for use. During procedure, dilatation was performed twice at 10 atm around the cephalic vein anastomosis (the angle was gently/slowly applied). The device was simply removed since the lesion area was properly expanded. However, one out of the four blade was missing even if excessive force more than usual was not used. The procedure was completed with this device. There were no complications reported and there was no problem with the patient.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 2134265-2020-04092 |
| MDR Report Key | 9903123 |
| Report Source | COMPANY REPRESENTATIVE,FOREIG |
| Date Received | 2020-03-31 |
| Date of Report | 2020-03-31 |
| Date of Event | 2020-03-09 |
| Date Mfgr Received | 2020-03-09 |
| Device Manufacturer Date | 2019-12-06 |
| Date Added to Maude | 2020-03-31 |
| 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 IRELAND LIMITED |
| 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 | 2CM PERIPHERAL CUTTING BALLOON |
| Generic Name | CATHETER, ANGIOPLASTY, PERIPHERAL, TRANSLUMINA |
| Product Code | LIT |
| Date Received | 2020-03-31 |
| Returned To Mfg | 2020-03-25 |
| Model Number | 24628 |
| Catalog Number | 24628 |
| Lot Number | 0024884443 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | R |
| Device Eval'ed by Mfgr | N |
| 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 | 2020-03-31 |