MAUDE Adverse Event Report: ABBOTT VASCULAR XIENCE SIERRA EVEROLIMUS ELUTING CORONARY STENT SYSTEM; DRUG ELUTING CORONARY STENT DELIVERY SYSTEM

Model Number 1550300-15

Device Problem Expiration Date Error (2528)

Patient Problem No Clinical Signs, Symptoms or Conditions (4582)

Event Date 02/01/2022

Event Type  malfunction  

Event Description

It was reported that the radio frequency identification (rfid) consignment tracking tag for the xience sierra stent delivery system (sds) is showing the wrong expiration year, the month and date are correct.The expiration date on the rfid tag is showing 12/22/2008.There was no device use or patient involvement.There was no clinically significant delay in the procedure.No additional information was provided.

Manufacturer Narrative

Date of event is estimated the device was not returned for analysis.A review of the electronic lot history record (elhr) and a lot level similar incident review for this product was not performed because the lot number was not reported and the product was not returned for analysis.The investigation determined the reported difficulties appear to be related to the format of the accounts barcode scanning setup as the account confirmed that their expiration date layout is set up differently than abbott vascular as they use dd/mm/yyyy format and abbott vascular barcode dates are set up yy/mm/dd.There is no indication of a product quality issue with respect to manufacture, design or labeling.The additional xience sierra device is being filed under a separate medwatch report number.

• Brand Name: XIENCE SIERRA EVEROLIMUS ELUTING CORONARY STENT SYSTEM
• Type of Device: DRUG ELUTING CORONARY STENT DELIVERY SYSTEM
• Manufacturer (Section D): ABBOTT VASCULAR; 26531 ynez rd.; temecula CA 92591 4628
• Manufacturer (Section G): ABBOTT VASCULAR, REG # 3005718570 (P031); cashel road; clonmel tipperary ; EI
• Manufacturer Contact: lindsey bell ; 26531 ynez rd.; temecula, CA 92591-4628 ; 9519143996
• MDR Report Key: 13894341
• MDR Text Key: 288036026
• Report Number: 2024168-2022-03122
• Device Sequence Number: 1
• Product Code: NIQ
• UDI-Device Identifier: 08717648227257
• UDI-Public: 08717648227257
• Combination Product (y/n): Y
• Reporter Country Code: US
• PMA/PMN Number: P110019
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Health Professional,Company Representative
• Reporter Occupation: Other Health Care Professional
• Type of Report: Initial
• Report Date: 03/24/2022

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Device Operator: Health Professional
• Device Model Number: 1550300-15
• Device Catalogue Number: 1550300-15
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Initial Date Manufacturer Received: 02/28/2022
• Initial Date FDA Received: 03/24/2022
• Was Device Evaluated by Manufacturer?: Device Not Returned to Manufacturer
• Is the Device Single Use?: Yes
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: Initial
• Patient Sequence Number: 1