MAUDE Adverse Event Report: BOSTON SCIENTIFIC CORPORATION 2CM PERIPHERAL CUTTING BALLOON; CATHETER, ANGIOPLASTY, PERIPHERAL, TRANSLUMINA

Model Number 24628

Device Problem Leak/Splash (1354)

Patient Problem No Clinical Signs, Symptoms or Conditions (4582)

Event Date 12/08/2021

Event Type  malfunction  

Event Description

It was reported that the balloon ruptured.A pcb2cm otw/5.0-20/4.2/50 was selected for use in a vascular access intervention therapy procedure, to treat a shunt failure.The 90% stenosed target lesion was located in the moderately tortuous and mildly calcified cephalic vein.During the procedure, it was noted that the balloon ruptured at 8 atmospheres upon second inflation.Each inflation was for one minute and pressure was 8 atmospheres for both inflations.A pinhole was observed on the balloon.The device was removed using the normal method without any problem and the procedure was completed with a different device.There were no complications reported and the patient is in good condition after the procedure.

Manufacturer Narrative

Device evaluated by mfr: the device was returned for evaluation.A visual examination identified that the balloon was not folded which indicates that the device was subjected to positive pressure.Blood was identified within the balloon which is evidence of a device leak.The rated burst pressure for this device is 10 atmospheres as per pcb2cm specification.The returned device was attached to an encore inflation unit.Positive pressure was applied when liquid was observed to be leaking from a balloon pinhole located approximately 10mm distal of the proximal markerband.An examination of the balloon material and markerbands identified no issues which could potentially have contributed to this complaint.A visual and microscopic examination observed no damage to the tip or blades.All blades were present and fully bonded to the balloon surface.A visual and tactile examination identified no kinks or damage to the shaft of the device.

Event Description

It was reported that the balloon ruptured.A pcb2cm otw /5.0-20/4.2/50 was selected for use in a vascular access intervention therapy procedure, to treat a shunt failure.The 90% stenosed target lesion was located in the moderately tortuous and mildly calcified cephalic vein.During the procedure, it was noted that the balloon ruptured at 8 atmospheres upon second inflation.Each inflation was for one minute and pressure was 8 atmospheres for both inflations.A pinhole was observed on the balloon.The device was removed using the normal method without any problem and the procedure was completed with a different device.There were no complications reported and the patient is in good condition after the procedure.

• Brand Name: 2CM PERIPHERAL CUTTING BALLOON
• Type of Device: CATHETER, ANGIOPLASTY, PERIPHERAL, TRANSLUMINA
• Manufacturer (Section D): BOSTON SCIENTIFIC CORPORATION; two scimed place; maple grove MN 55311
• Manufacturer (Section G): BOSTON SCIENTIFIC CORPORATION; ballybrit business park; galway ; EI
• Manufacturer Contact: jay johnson ; two scimed place; maple grove, MN 55311 ; 7634942574
• MDR Report Key: 13087408
• MDR Text Key: 282779179
• Report Number: 2134265-2021-16195
• Device Sequence Number: 1
• Product Code: LIT
• Combination Product (y/n): N
• Reporter Country Code: JA
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Foreign,Health Professional,Company Representative,Distributor
• Reporter Occupation: Physician
• Type of Report: Initial,Followup
• Report Date: 02/02/2022

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 12/27/2021
• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Device Operator: Health Professional
• Device Expiration Date: 08/25/2023
• Device Model Number: 24628
• Device Catalogue Number: 24628
• Device Lot Number: 0027902570
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 01/04/2022
• Is the Reporter a Health Professional?: Yes
• Date Manufacturer Received: 01/12/2022
• Was Device Evaluated by Manufacturer?: Yes
• Date Device Manufactured: 08/25/2021
• Is the Device Single Use?: Yes
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: Initial
• Patient Sequence Number: 1