MAUDE Adverse Event Report: MERIT MEDICAL SYSTEMS, INC. - RESOLVE CONVERTX®; STENT, URETERAL

Model Number 00884450458587

Device Problem Activation, Positioning or Separation Problem (2906)

Patient Problem No Clinical Signs, Symptoms or Conditions (4582)

Event Date 04/24/2023

Event Type  malfunction  

Event Description

The account alleges that during the number insertion, the nephroureteral stent system came out completely instead of just 2 centimeters.The physician had to cut the catheter to dislodge the stent.No patient harm.

Manufacturer Narrative

The suspect device is not expected to return for evaluation.A follow up will be submitted when the evaluation is complete.

Manufacturer Narrative

The suspect medical device was not returned for evaluation.The complaint could not be confirmed.The root cause could not be determined.The device history record was reviewed, and no exception documents were found.A search of the complaint database was performed and no similar complaints for this lot number have been identified.Should the device be returned at a later date, the investigation will be reopened.

• Brand Name: RESOLVE CONVERTX®
• Type of Device: STENT, URETERAL
• Manufacturer (Section D): MERIT MEDICAL SYSTEMS, INC. -; 14646 kirby drive; houston TX 77047
• Manufacturer (Section G): MERIT MEDICAL SYSTEMS, INC.; 14646 kirby drive; houston TX 77047
• Manufacturer Contact: bryson heaton ; 1600 merit parkway; south jordan, UT 84095 ; 8012084662
• MDR Report Key: 16860401
• MDR Text Key: 314712918
• Report Number: 3010665433-2023-00035
• Device Sequence Number: 1
• Product Code: FAD
• UDI-Device Identifier: 00884450458587
• UDI-Public: 00884450458587
• Combination Product (y/n): N
• Reporter Country Code: US
• PMA/PMN Number: K161277
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: User Facility,Company Representative
• Reporter Occupation: Other
• Type of Report: Initial,Followup
• Report Date: 04/24/2023

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Device Operator: Health Professional
• Device Model Number: 00884450458587
• Device Catalogue Number: RCX26-8-038/A
• Device Lot Number: E2490990
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: No
• Initial Date Manufacturer Received: 04/24/2023
• Initial Date FDA Received: 05/03/2023
• Supplement Dates Manufacturer Received: 06/22/2023
• Supplement Dates FDA Received: 06/27/2023
• Was Device Evaluated by Manufacturer?: Device Not Returned to Manufacturer
• Date Device Manufactured: 11/07/2022
• 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