MAUDE MDR 9908295

MDR report key
9908295
Report number
2024168-2020-03175
Event key
0
Event type
3
Date of event
2020-03-09
Date received
2020-03-31
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
1NC TRAVELER RXCORONARY DILATATION CATHETERABBOTT VASCULARLOX1013159-0890412G1R N

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12020-03-310

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. THE INVESTIGATION DETERMINED THE REPORTED DIFFICULTIES APPEAR TO BE RELATED TO CIRCUMSTANCES OF THE PROCEDURE. THERE IS NO INDICATION OF A PRODUCT QUALITY ISSUE WITH RESPECTS TO THE DESIGN, MANUFACTURE, OR LABELING OF THE DEVICE.

D

Patient 1

IT WAS REPORTED THAT THE PROCEDURE WAS PERFORMED TO TREAT A LESION IN THE HEAVILY CALCIFIED LEFT ANTERIOR DESCENDING (LAD) ARTERY. RESISTANCE WAS MET DURING ADVANCEMENT, DUE TO THE PATIENT ANATOMY. THE 5.0 X 8 MM NC TRAVELER DILATATION CATHETER WAS INFLATED TO PERFORM POST DILATATION OF A XIENCE SIERRA STENT. DURING INFLATION TO 10 ATMOSPHERES (ATM), THE BALLOON RUPTURED. IT WAS NOTED THAT THE AIR PRESSURE INSIDE THE INDEFLATOR FAILED TO RISE AND CONTRAST LEAKAGE WAS NOTED ON ANGIOGRAPHY. THE NC TRAVELER DILATATION CATHETER WAS REMOVED WITHOUT RESISTANCE AND POST DILATATION WAS PERFORMED USING A NON-ABBOTT DILATATION CATHETER. THERE WERE NO ADVERSE PATIENT EFFECTS AND NO CLINICALLY SIGNIFICANT DELAY. NO ADDITIONAL INFORMATION WAS PROVIDED.