MAUDE Adverse Event Report: CONCERT MEDICAL, LLC GALEO PRO F CORONARY GUIDEWIRE

Model Number 512040-002

Device Problem Flaked (1246)

Patient Problem No Consequences Or Impact To Patient (2199)

Event Date 11/18/2016

Event Type  malfunction  

Manufacturer Narrative

Portions of the ptfe guidewire coating were delaminated.This problem is under investigation by the manufacturer.

Event Description

Ptfe coating separated from the guidewire.No patient injury or other complications reported.

• Brand Name: GALEO PRO F CORONARY GUIDEWIRE
• Type of Device: CORONARY GUIDEWIRE
• Manufacturer (Section D): CONCERT MEDICAL, LLC; 77 accord park drive; norwell MA 02061
• Manufacturer (Section G): CONCERT MEDICAL, LLC; 77 accord park drive; norwell MA 02061
• Manufacturer Contact: timothy powers ; 77 accord park drive; norwell, MA 02061 ; 7812617407
• MDR Report Key: 6241522
• MDR Text Key: 64616869
• Report Number: 1223414-2017-00002
• Device Sequence Number: 1
• Product Code: DQX
• UDI-Device Identifier: 00814384020215
• UDI-Public: 00814384020215
• Combination Product (y/n): N
• Reporter Country Code: SZ
• PMA/PMN Number: K090193
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: distributor,foreign,health pr
• Reporter Occupation: Other
• Type of Report: Initial
• Report Date: 01/10/2017

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: Physician
• Device Expiration Date: 10/31/2019
• Device Model Number: 512040-002
• Device Catalogue Number: 389783
• Device Lot Number: 00577932
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 12/22/2016
• Is the Reporter a Health Professional?: No
• Initial Date Manufacturer Received: 11/29/2016
• Initial Date FDA Received: 01/11/2017
• Was Device Evaluated by Manufacturer?: Yes
• Date Device Manufactured: 11/14/2014
• 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
• Treatment: GUIDING CATHETER
• Patient Outcome(s): Other
• Patient Age: 65 YR