MAUDE Adverse Event Report: SPECTRANETICS STELLAREX 0.035 OTW DRUG-COATED ANGIOPLASTY BALLOON; DCB PTA CATHETER

Model Number A35DC05012013IO

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

Patient Problem Death (1802)

Event Date 01/09/2015

Event Type  Death  

Manufacturer Narrative

The patient's cause of death was unrelated to the study device.This is being reported as a follow-up to the clinical study.Patient information regarding relevant tests/laboratory data is unknown.This information was not available from the facility.Udi and pma numbers are not applicable.This device was used in clinical application prior to being available in the us.Foreign- belgium/ study name: illuminate global- patient id #(b)(6).During the index procedure, the product worked as intended and the device was discarded, thus no product evaluation was performed.Per the ifu, death is listed as potential complications/adverse.

Event Description

It was reported through a clinical study that during the index procedure on (b)(6) 2015, a stellarex catheter was used to treat the target lesion of the right distal sfa.Approximately 54 months post index procedure, the patient expired from carcinoma of the right lung on (b)(6)2019.The physician indicated this is not related to the study device or procedure.

• Brand Name: STELLAREX 0.035 OTW DRUG-COATED ANGIOPLASTY BALLOON
• Type of Device: DCB PTA CATHETER
• Manufacturer (Section D): SPECTRANETICS; 6531 dumbarton circle; fremont CA 94555
• Manufacturer (Section G): SPECTRANETICS; 6531 dumbarton circle; fremont CA 94555
• Manufacturer Contact: ana tan ; 5055 brandin court; fremont, CA 94538 ; 510933-798
• MDR Report Key: 9440833
• MDR Text Key: 170004636
• Report Number: 3009784280-2019-00712
• Device Sequence Number: 1
• Product Code: ONU
• Combination Product (y/n): Y
• Reporter Country Code: BE
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: foreign,study
• Reporter Occupation: Physician
• Type of Report: Initial
• Report Date: 01/01/2005,12/04/2019

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 12/09/2019
• Is this an Adverse Event Report?: Yes
• Device Operator: Health Professional
• Device Expiration Date: 03/03/2015
• Device Model Number: A35DC05012013IO
• Device Catalogue Number: A35DC05012013IO
• Device Lot Number: 14H2651202
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Was the Report Sent to FDA?: Yes
• Date Report Sent to FDA: 01/01/2005
• Date Report to Manufacturer: 01/10/2005
• Date Manufacturer Received: 12/04/2019
• Is This a Reprocessed and Reused Single-Use Device?: No
• Patient Sequence Number: 1
• Patient Outcome(s): Other
• Patient Age: 63 YR
• Patient Weight: 84