MAUDE Adverse Event Report: BOSTON SCIENTIFIC CORPORATION PROMUS PREMIER SELECT; STENT, CORONARY, DRUG-ELUTING

Model Number 10663

Device Problem Obstruction of Flow (2423)

Patient Problem Myocardial Infarction (1969)

Event Date 09/21/2023

Event Type  Injury  

Event Description

It was reported that patient experienced myocardial infarction and stents occlusion occurred.On (b)(6) 2020, after angiography performed, two 16 x 2.75 promus premier select stents were deployed at the target lesion.On (b)(6) 2023, patient experienced a sudden blockage and heart attack.There was no additional information.

Manufacturer Narrative

E1: initial reporter facility name: added the manufacture name.

Event Description

It was reported that patient experienced myocardial infarction and stents occlusion occurred.On (b)(6) 2020, after angiography performed, two 16 x 2.75 promus premier select stents were deployed at the target lesion.On september 21, 2023, patient experienced a sudden blockage and heart attack.There was no additional information.

• Brand Name: PROMUS PREMIER SELECT
• Type of Device: STENT, CORONARY, DRUG-ELUTING
• Manufacturer (Section D): BOSTON SCIENTIFIC CORPORATION; 300 boston scientific way; marlborough MA 01752
• Manufacturer (Section G): BOSTON SCIENTIFIC CORPORATION; ballybrit business park; galway ; EI
• Manufacturer Contact: rachel shields ; 4100 hamline ave n; arden hills, MN 55112 ; 6512422111
• MDR Report Key: 17938768
• MDR Text Key: 325719060
• Report Number: 2124215-2023-57078
• Device Sequence Number: 1
• Product Code: NIQ
• Combination Product (y/n): Y
• Reporter Country Code: US
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Foreign,Consumer,Company Representative
• Reporter Occupation: Other
• Type of Report: Initial,Followup
• Report Date: 10/18/2023

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 10/16/2023
• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: Yes
• Device Operator: Health Professional
• Device Expiration Date: 04/09/2022
• Device Model Number: 10663
• Device Catalogue Number: 10663
• Device Lot Number: 0025452187
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: No
• Date Manufacturer Received: 10/18/2023
• Was Device Evaluated by Manufacturer?: Device Not Returned to Manufacturer
• Date Device Manufactured: 04/09/2020
• 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
• Patient Outcome(s): Other