MAUDE Adverse Event Report: ABBOTT VASCULAR NC TREK CORONARY DILATATION CATHETER

Model Number	1012451-08
Medical Device Problem Codes	Material Rupture (1546); Difficult to Advance (2920)
Health Effect - Clinical Code	No Consequences Or Impact To Patient (2199)
Date of Event	09/03/2020
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
The product was not returned to abbott vascular for analysis.A review of the lot history record identified no manufacturing nonconformities issued to the reported lot that would have contributed to this event.Additionally, a review of the complaint history identified no other incidents reported from this lot.In this case, the device was prepped prior to use and inflated twice prior to the balloon rupture without issues or leak noted.The investigation determined the reported difficulty to advance and balloon rupture appear to be related to operational circumstances of the procedure.Based on the reported information, during advancement, the balloon catheter encountered resistance with an unspecified stent, likely causing damage to the outer surface of the balloon ultimately resulting in the reported balloon rupture during the third inflation at 12 atmospheres.There is no indication of a product quality issue with respect to manufacture, design or labeling of the device.Na.
Event or Problem Description
It was reported that the procedure was performed to treat a de novo lesion with moderate calcification, heavy tortuosity, and 90% stenosis in the mid-right coronary artery.A 3.5 x 8 mm nc trek balloon dilatation catheter (bdc) was advanced to perform post-dilatation; however, resistance was met inside an unspecified stent during advancement and the balloon ruptured on the third inflation at 12 atmospheres.The bdc was removed from the patient¿s anatomy and there were no issues confirmed by ivus.The procedure ended at this point.There were no adverse patient effects and no clinically significant delay in the procedure.No additional information was provided.

• Brand Name: NC TREK CORONARY DILATATION CATHETER
• Common Device Name: CORONARY DILATATION CATHETER
• Manufacturer (Section D): ABBOTT VASCULAR; 26531 ynez rd.; temecula CA 92591 4628
• MDR Report Key: 10603332
• Report Number: 2024168-2020-08111
• Device Sequence Number: 19788049
• Product Code: LOX
• UDI-Device Identifier: 08717648151965
• UDI-Public: 08717648151965
• Combination Product (Y/N): N
• Initial Reporter Country: JA
• PMA/510(K) Number: K103153
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: company representative,distri
• Initial Reporter Occupation: Physician
• Type of Report: Initial
• Report Date (Section B): 09/29/2020

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: Health Professional
• Device Expiration Date: 08/31/2022
• Device Model Number: 1012451-08
• Device Catalogue Number: 1012451-08
• Device Lot Number: 90907G1
• Was Device Available for Evaluation?: No
• Type of Report(Section G): Initial
• Initial Date Received by Manufacturer: 09/23/2020
• Initial Report FDA Received Date: 09/29/2020
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1