Model Number A35SX040120080 |
Device Problem
Adverse Event Without Identified Device or Use Problem (2993)
|
Patient Problem
Cardiac Arrest (1762)
|
Event Date 04/10/2018 |
Event Type
Death
|
Manufacturer Narrative
|
The patient's ethnicity and race are unknown.This information was not available from the facility.The patient's cause of death was unrelated to the study device or procedure.This is being reported as a follow-up to the clinical registry.Cross reference mfr report numbers: 3009784280-2021-00021.Patient information regarding relevant tests/laboratory data is unknown.This information was not available from the facility.Report source: foreign- (b)(6)/ study name: (b)(6): patient id #(b)(6).Pma number is not applicable.The device is a commercial product with a ce mark that was used as part of a clinical registry.During the index procedure, the product worked as intended and the device was discarded, thus no product evaluation was required.The health effect impact code (heic) field was intentionally left blank.A supplemental mdr to follow upon availability.
|
|
Event Description
|
It was reported through a clinical registry that during the index procedure on (b)(6) 2018, two stellarex catheters were used to treat the target lesion of the left distal sfa.Approximately 31 months post index procedure, the patient expired due to cardiac arrest on (b)(6) 2020.The physician indicated this is not related to the study device or procedure.
|
|
Manufacturer Narrative
|
The health effect impact code (heic) field was intentionally left blank.A supplemental mdr to follow upon availability to enter code: 1802 (death).
|
|
Manufacturer Narrative
|
Block h6: added code 1802 (death).Although the cause of death is unrelated to the study device, death is listed in the ifu as a potential complications/ adverse events.Component codes intentionally left blank.No device malfunction was reported during the index procedure.
|
|
Manufacturer Narrative
|
Block h1 (no.Of events (noe) summarized): in the initial report, the xml file shows the summary report and 123 events were included.However, this was inadvertently included due to a system error in the xml file, as it was not visible in the pdf copy.This field should be left blank.
|
|
Search Alerts/Recalls
|