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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: BOSTON SCIENTIFIC CORPORATION STERLING; CATHETER, PERCUTANEOUS
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BOSTON SCIENTIFIC CORPORATION STERLING; CATHETER, PERCUTANEOUS Back to Search Results
Model Number 24690
Medical Device Problem Code Material Rupture (1546)
Health Effect - Clinical Code No Clinical Signs, Symptoms or Conditions (4582)
Date of Event 07/13/2021
Type of Reportable Event Malfunction
Additional Manufacturer Narrative
Initial reporter address 1: (b)(6).Initial reporter city: (b)(6).
 
Event or Problem Description
It was reported that balloon rupture occurred.The 95% stenosed target lesion was located in moderately tortuous and severely calcified superficial femoral artery.A 3.0mm x 60mm x 135cm sterling balloon catheter was advanced for dilatation.However, during the first inflation at 6 atmospheres in 5 seconds, the balloon was ruptured.The device was removed and the procedure was completed with another of same device.There were no patient complications nor injuries reported and the patient condition was good.
 
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Brand Name
STERLING
Common Device Name
CATHETER, PERCUTANEOUS
Manufacturer (Section D)
BOSTON SCIENTIFIC CORPORATION
two scimed place
maple grove MN 55311
MDR Report Key12222362
Report Number2134265-2021-09523
Device Sequence Number19763860
Product Code DQY
UDI-Device Identifier08714729756897
UDI-Public08714729756897
Combination Product (Y/N)N
Initial Reporter CountryJA
PMA/510(K) Number
K141150
Number of Events Summarized1
Summary Report (Y/N)N
Serviced by Third Party (Y/N)Unknown
Reporter Type Manufacturer
Report Source company representative,distri
Initial Reporter Occupation Physician
Type of Report Initial
Report Date (Section B) 07/23/2021
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 Date06/02/2022
Device Model Number24690
Device Catalogue Number24690
Device Lot Number0023888478
Was Device Available for Evaluation? No
Type of Report(Section G)Initial
Initial Date Received by Manufacturer 07/13/2021
Initial Report FDA Received Date07/23/2021
Is This a Single-Use Device that was
Reprocessed and Reused on a Patient? (Y/N)		 No
Patient Sequence Number1
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