MAUDE Adverse Event Report: ABBOTT VASCULAR XIENCE SIERRA EVEROLIMUS ELUTING CORONARY STENT SYSTEM DRUG ELUTING CORONARY STENT DELIVERY SYSTEM

Model Number 1550300-15

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

Patient Problems Angina (1710); Cardiac Enzyme Elevation (1838); Stenosis (2263); Test Result (2695)

Event Date 12/31/2019

Event Type  Injury  

Manufacturer Narrative

The stent remains in the patient. Investigation is not yet complete. A follow up report will be submitted with all additional relevant information.

Event Description

Patient id: (b)(6). It was reported that on (b)(6) 2019, a percutaneous coronary intervention was performed on the right coronary artery (rca), 95% stenosed lesion. A 3. 0x15mm xience sierra stent (1550300-15, 9011441) was implanted in the distal rca without complication. Following, a 3. 0x18 and a 3. 5x18mm xience sierra stent were implanted in the mid rca without complication. Acceptable results were noted as the rca was observed with timi flow iii and 0% diameter stenosis following stent implantation. On (b)(6) 2019, the patient experienced worsening jaw pain and a positive non-stress test was noted. The patient was admitted to the hospital with coronary artery disease. Another cardiac catheritization was performed and target vessel disease was observed. 80% proximal lad stenosis, 99% distal lcx stenosis, 99% proximal rca stenosis, widely patent stent (stent not specified), and 70% distal rca stenosis. On (b)(6) 2020, a coronary artery bypass graft (cabg) was performed in the lad, om and pda. Elevated troponin was noted following. The event resolved without sequela. No additional information was provided regarding this issue.

• Brand Name: XIENCE SIERRA EVEROLIMUS ELUTING CORONARY STENT SYSTEM
• Type of Device: DRUG ELUTING CORONARY STENT DELIVERY SYSTEM
• Manufacturer (Section D): ABBOTT VASCULAR; 26531 ynez rd.; temecula CA 92591 4628
• Manufacturer (Section G): ABBOTT VASCULAR, REG # 3005718570 (P099); cashel road; clonmel tipperary ; EI
• Manufacturer Contact: lindsey bell ; 26531 ynez rd.; temecula, CA 92591-4628 ; 9519143996
• MDR Report Key: 10261450
• MDR Text Key: 198529295
• Report Number: 2024168-2020-05693
• Device Sequence Number: 1
• Product Code: NIQ
• Combination Product (y/n): Y
• Reporter Country Code: US
• PMA/PMN Number: P110019
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: health professional,study

Reporter Occupation

• Type of Report: Initial,Followup
• Report Date: 08/21/2020

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 07/10/2020
• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: No

Device Operator

• Device Expiration Date: 01/20/2020
• Device Model Number: 1550300-15
• Device Catalogue Number: 1550300-15
• Device Lot Number: 9011441
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes

Was the Report Sent to FDA?

• Event Location: No Information
• Date Manufacturer Received: 08/19/2020
• Was Device Evaluated by Manufacturer?: Device Not Returned to Manufacturer
• Date Device Manufactured: 01/21/2019
• Is the Device Single Use?: Yes
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: Initial

Patient Treatment Data

Date Received: 07/10/2020 Patient Sequence Number: 1