MAUDE Adverse Event Report: MICRO THERAPEUTICS, INC. DBA EV3 REACT CATHETER; CATHETER, PERCUTANEOUS

Model Number REACT-71

Device Problem Adverse Event Without Identified Device or Use Problem (2993)

Patient Problems Fever (1858); Unspecified Infection (1930)

Event Date 10/24/2021

Event Type  Injury  

Event Description

Medtronic received a report that the patient experienced a urinary tract infection and fever 5 days after a solitaire procedure.The patient was administered antibiotics and was hospitalized from (b)(6) 2021 to (b)(6) 2021.The event was noted as recovering/resolving.The adverse event was not the result of a device deficiency.The site assessed the event as not related to the disease under study, an underlying condition, the device, or the procedure.The sponsor assessed the event as possibly related to the procedure.The patient was undergoing treatment for a clot located in the m1 section of the right middle cerebral artery.The patient's pre-procedure mtici score was 0, and post-procedure it was 3. the patient's nihss score was 28. the following test results were taken on (b)(6) 2021: cell blood count was 9.29g/l, creatinine was 205mcmol/l, hemoglobin was 87g/l.  ancillary devices include a react 71 catheter.

Manufacturer Narrative

If information is provided in the future, a supplemental report will be issued.

• Brand Name: REACT CATHETER
• Type of Device: CATHETER, PERCUTANEOUS
• Manufacturer (Section D): MICRO THERAPEUTICS, INC. DBA EV3; 9775 toledo way; irvine CA 92618
• Manufacturer (Section G): MICRO THERAPEUTICS, INC. DBA EV3; 9775 toledo way; irvine CA 92618
• Manufacturer Contact: glen belmer ; 9775 toledo way; irvine, CA 92618 ; 6122713209
• MDR Report Key: 12917041
• MDR Text Key: 285343020
• Report Number: 2029214-2021-01555
• Device Sequence Number: 1
• Product Code: DQY
• Combination Product (y/n): N
• Reporter Country Code: SZ
• PMA/PMN Number: K182097
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Foreign,Study,Health Professional
• Reporter Occupation: Physician
• Type of Report: Initial
• Report Date: 12/02/2021

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 12/02/2021
• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: No
• Device Operator: Health Professional
• Device Expiration Date: 03/18/2023
• Device Model Number: REACT-71
• Device Catalogue Number: REACT-71
• Device Lot Number: B179288
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Date Manufacturer Received: 11/16/2021
• Date Device Manufactured: 03/22/2021
• 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): Hospitalization; Required Intervention
• Patient Age: 75 YR
• Patient Sex: Male
• Patient Weight: 76 KG