MAUDE Adverse Event Report: BOSTON SCIENTIFIC CORPORATION RENEGADE HI-FLO; CATHETER, CONTINUOUS FLUSH

Model Number	29420
Medical Device Problem Code	Material Integrity Problem (2978)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	10/24/2021
Type of Reportable Event	Malfunction
Event or Problem Description
It was reported that the hydrophobic coating fell off.A 135/10 renegade hi-flo was selected for use.During unpacking, the device was flushed with sterile injection water.When the device was taken out, it was noted that the hydrophobic coating fell off.The procedure was completed with another of same device.No patient complications were reported and the patient was stable post procedure.
Event or Problem Description
It was reported that the hydrophobic coating fell off.A 135/10 renegade hi-flo was selected for use.During unpacking, the device was flushed with sterile injection water.When the device was taken out, it was noted that the hydrophobic coating fell off.The procedure was completed with another of same device.No patient complications were reported and the patient was stable post procedure.
Additional Manufacturer Narrative
Device evaluated by manufacturer: the device was returned for analysis.The device was received in the shipping hoop.The hoop was hydrated, and the device was removed.The device was inspected for any damage or irregularities.The device showed damage in the form of a fracture located 8.8cm from the hub.The device also showed stretching 5.5cm from the hub.The device was not completely separated the inner liner was still attached.There were no coating issues noticed on the catheter shaft.The coating looked to be smooth and uniform.Inspection of the remainder of the device, apart from the observed damage, revealed no other damage or irregularities.The device was not confirmed for coating issues; however, stretching and a fracture were confirmed.

• Brand Name: RENEGADE HI-FLO
• Common Device Name: CATHETER, CONTINUOUS FLUSH
• Manufacturer (Section D): BOSTON SCIENTIFIC CORPORATION; two scimed place; maple grove MN 55311
• Manufacturer (Section G): BOSTON SCIENTIFIC CORK LIMITED; model farm road; cork ; EI
• Manufacturer Contact: jay johnson ; two scimed place; maple grove, MN 55311 ; 7634942574
• MDR Report Key: 12804553
• Report Number: 2134265-2021-13850
• Device Sequence Number: 14846594
• Product Code: KRA
• UDI-Device Identifier: 08714729280637
• UDI-Public: 08714729280637
• Combination Product (Y/N): N
• Initial Reporter Country: CH
• PMA/510(K) Number: K140329
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): Unknown
• Reporter Type: Manufacturer
• Report Source: Foreign,Health Professional,Company Representative
• Initial Reporter Occupation: Physician
• Type of Report: Initial,Followup
• Report Date (Section B): 12/13/2021

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: 11/05/2022
• Device Model Number: 29420
• Device Catalogue Number: 29420
• Device Lot Number: 0024885471
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 11/23/2021
• Is the Reporter a Health Professional?: Yes
• Type of Report(Section G): Follow-Up
• Initial Date Received by Manufacturer: 10/25/2021
• Supplement Date Received by Manufacturer: 11/30/2021
• Initial Report FDA Received Date: 11/12/2021
• Supplement Report FDA Received Date: 12/13/2021
• Was Device Evaluated by Manufacturer? (Y/N): Yes
• Date Device Manufactured: 12/06/2019
• Is the Device Labeled for Single Use? (Y/N): Yes
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Usage of Device: Initial
• Patient Sequence Number: 1
• Patient Age: 59 YR
• Patient Sex: Male
• Patient Weight: 60 KG