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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: BARD PERIPHERAL VASCULAR, INC. CONQUEST PTA DILATATION CATHETER; PTA BALLOON DILATATION CATHETER
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BARD PERIPHERAL VASCULAR, INC. CONQUEST PTA DILATATION CATHETER; PTA BALLOON DILATATION CATHETER Back to Search Results
Model Number CQ7588
Medical Device Problem Codes Material Frayed (1262); Material Rupture (1546); Unraveled Material (1664)
Health Effect - Clinical Code No Consequences Or Impact To Patient (2199)
Type of Reportable Event Malfunction
Additional Manufacturer Narrative
The lot number was provided; therefore, a lot history review was performed.The device was returned for evaluation.Therefore, the investigation is confirmed for the reported balloon rupture,unraveled and frayed fibers.The definitive root cause is unknown.The device is labeled for single use.
 
Event or Problem Description
This report summarizes one malfunction.A review of the reported malfunction indicated that model cq7588 pta balloon dilatation catheter allegedly ruptured, material frayed and unraveled material.This report was received from one source.One patient was involved with no reported patient injury.The male patient is (b)(6) years old.Weight was not provided.
 
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Brand Name
CONQUEST PTA DILATATION CATHETER
Common Device Name
PTA BALLOON DILATATION CATHETER
Manufacturer (Section D)
BARD PERIPHERAL VASCULAR, INC.
1625 w 3rd st.
tempe AZ 85281
MDR Report Key10286884
Report Number2020394-2020-04564
Device Sequence Number18961807
Product Code DQY
UDI-Device Identifier00801741063138
UDI-Public(01)00801741063138
Combination Product (Y/N)N
Initial Reporter StateAZ
Initial Reporter CountryUS
Number of Events Summarized1
Summary Report (Y/N)N
Reporter Type Manufacturer
Initial Reporter Occupation Other
Type of Report Initial
Report Date (Section B) 07/16/2020
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
Operator of Device No Information
Device Model NumberCQ7588
Device Catalogue NumberCQ7588
Device Lot NumberREDV2291
Type of Report(Section G)Thirty-Day
Initial Date Received by Manufacturer 06/30/2020
Initial Report FDA Received Date07/16/2020
Patient Sequence Number1
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