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

Model Number A35SX060120135

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

Patient Problems Cancer (3262); Insufficient Information (4580)

Event Date 03/19/2019

Event Type  Death  

Manufacturer Narrative

The patient's date of birth is unknown.This information was not available from the facility.Foreign report source: (b)(6).Pma number is not applicable.The device is a non-commercial product with a ce mark that was used as part of a clinical study.During the index procedure, the product worked as intended and the device was discarded, thus no product evaluation was performed.Although the cause of death is unrelated to the study device, death is listed in the ifu as a potential complications/ adverse events.

Event Description

It was reported through a clinical study that during the index procedure on (b)(6) 2019, three stellarex catheters (3011416935-2022-00005, 3011416935-2022-00006) were used to treat the target lesion of the left proximal, mid, and distal sfa.Approximately 36 months post index procedure, it was reported that the patient expired.The date and cause of death is unknown.The physician indicated this is not related to the study device or procedure.This adverse event is being submitted because the patient expired.The cause of death is unknown, however it was not related to the study device or procedure.This is being reported as a follow-up to the clinical study.

Manufacturer Narrative

Block b5: updated to add clinical evaluation and cause of death.

Event Description

Approximately 20 months post index procedure, it was reported that the patient was diagnosed with lung cancer.Per clinical evaluation, the patient likely died from cancer and/or complications of chemotherapy related to the cancer.

• Brand Name: STELLAREX 0.035 OTW DRUG-COATED ANGIOPLASTY BALLOON
• Type of Device: DCB PTA CATHETER
• Manufacturer (Section D): THE SPECTRANETICS CORPORATION; 6655 wedgwood road north; suite 105; maple grove MN 55311
• Manufacturer (Section G): SPECTRANETICS; 6655 wedgwood road north; suite 105; maple grove MN 55311
• Manufacturer Contact: diana melliza galvez ; 6655 wedgwood road north; suite 105; maple grove, MN 55311
• MDR Report Key: 13904536
• MDR Text Key: 287917404
• Report Number: 3011416935-2022-00007
• Device Sequence Number: 1
• Product Code: ONU
• Combination Product (y/n): Y
• Reporter Country Code: GM
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Foreign,Study
• Reporter Occupation: Physician
• Type of Report: Initial,Followup
• Report Date: 03/15/2022

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: No
• Device Operator: Health Professional
• Device Expiration Date: 02/14/2020
• Device Model Number: A35SX060120135
• Device Catalogue Number: A35SX060120135
• Device Lot Number: FG618B03A
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Was the Report Sent to FDA?: No
• Initial Date Manufacturer Received: 03/15/2022
• Initial Date FDA Received: 03/25/2022
• Supplement Dates Manufacturer Received: 04/20/2022
• Supplement Dates FDA Received: 05/10/2022
• Was Device Evaluated by Manufacturer?: Device Not Returned to Manufacturer
• Date Device Manufactured: 02/14/2018
• 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
• Patient Age: 83 YR
• Patient Sex: Male
• Patient Weight: 89 KG
• Patient Ethnicity: Non Hispanic
• Patient Race: White