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

Model Number	1804400-08
Medical Device Problem Codes	Difficult to Remove (1528); Failure to Advance (2524)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	05/19/2021
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
The customer reported the device is not returning.Investigation is not yet complete.A follow-up report will be submitted with all additional relevant information.
Event or Problem Description
It was reported that the procedure was to treat a heavily calcified, heavily tortuous mid right coronary artery that is 100% stenosed.A 4.0x08mm xience skypoint was attempted to be advanced; however, met resistance with anatomy.It was noted during removal resistance was also met with anatomy.The procedure was completed with a non-abbott stent.There was no adverse patient effects and no clinically significant delay reported.No additional information was provided.
Event or Problem Description
It was reported that the procedure was to treat a heavily calcified, heavily tortuous mid right coronary artery that is 100% stenosed.A 4.0x08mm xience skypoint was attempted to be advance; however, met resistance with anatomy.It was noted during removal resistance was also met with anatomy.The procedure was completed with a non-abbott stent.There was no adverse patient effects and no clinically significant delay reported.Subsequently after initial was filed it was confirmed the device failed to cross due to anatomy and there was no clinically significant delay.No additional information was provided.
Additional Manufacturer Narrative
The device was not returned for analysis.A review of the lot history record revealed no manufacturing nonconformities that would have contributed to this complaint.Additionally, a review of the complaint history did not indicate a lot specific quality issue.The investigation determined the reported difficulties appear to be related to the operational context of the procedure.There is no indication of a product quality issue with respect to manufacture, design or labeling.B7: was updated to "the account contact declined to provide missing patient information due to hospital policy".

• Brand Name: XIENCE SKYPOINT DRUG ELUTING CORONARY STENT DELIVERY SYSTEM
• Common Device Name: DRUG ELUTING CORONARY STENT DELIVERY SYSTEM
• Manufacturer (Section D): ABBOTT VASCULAR; 26531 ynez rd.; temecula CA 92591 4628
• MDR Report Key: 12193207
• Report Number: 2024168-2021-06196
• Device Sequence Number: 3900780
• Product Code: NIQ
• UDI-Device Identifier: 08717648233456
• UDI-Public: 08717648233456
• Combination Product (Y/N): Y
• Initial Reporter Country: JA
• PMA/510(K) Number: P110019
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): N
• Reporter Type: Manufacturer
• Report Source: company representative,distri
• Initial Reporter Occupation: Physician
• Type of Report: Initial,Followup
• Report Date (Section B): 09/28/2021

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: 09/09/2023
• Device Model Number: 1804400-08
• Device Catalogue Number: 1804400-08
• Device Lot Number: 0090241
• Was Device Available for Evaluation?: No
• Initial Date Received by Manufacturer: 06/28/2021
• Supplement Date Received by Manufacturer: 09/08/2021
• Initial Report FDA Received Date: 07/19/2021
• Supplement Report FDA Received Date: 09/28/2021
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1
• Patient Age: 62 YR
• Patient Weight: 90