MAUDE Adverse Event Report: BOSTON SCIENTIFIC CORPORATION MUSTANG; CATHETER, BILIARY, DIAGNOSTIC

Model Number	24674
Medical Device Problem Code	Material Rupture (1546)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	02/11/2022
Type of Reportable Event	Malfunction
Event or Problem Description
It was reported that balloon rupture occurred.Th patient presented with thrombosis.The target lesion was located in the iliac vein.A 12.0 x 80, 135cm mustang balloon catheter was advanced for dilation.However, during inflation, the balloon burst.The procedure was completed with another of the same device.There were no patient complications and the patient status was stable.
Event or Problem Description
It was reported that balloon rupture occurred.The target lesion was located in the iliac vein.A 12.0 x 80, 135cm mustang balloon catheter was advanced for dilation.However, during inflation, the balloon burst.The procedure was completed with another of the same device.There were no patient complicaitons and the patient was stable.It was further reported that the balloon ruptured during first inflation at less working pressure for few seconds.
Additional Manufacturer Narrative
Device evaluated by mfr.: a mustang was returned analysis.A visual examination identified that the balloon was not folded which indicates that the balloon was subjected to positive pressure.A longitudinal tear was identified in the balloon material.The tear measured approximately 85mm in length and extended from a position 10mm proximal of the proximal marker band to 11mm distal of the distal marker band.An examination of the balloon material and marker bands identified no issues which could potentially have contributed to this complaint.A visual examination observed no damage to the tip of the device.A visual and tactile examination found no kinks or damage to the shaft of the device.Both marker bands were undamaged and present on the shaft of the device.
Event or Problem Description
It was reported that balloon rupture occurred.The target lesion was located in the iliac vein.A 12.0 x 80, 135cm mustang balloon catheter was advanced for dilation.However, during inflation, the balloon burst.The procedure was completed with another of the same device.There were no patient complications and the patient was stable.It was further reported that the balloon ruptured during first inflation at less working pressure for few seconds.

• Brand Name: MUSTANG
• Common Device Name: CATHETER, BILIARY, DIAGNOSTIC
• 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 ; 4100 hamline ave n; arden hills, MN 55112 ; 6515810888
• MDR Report Key: 13657615
• Report Number: 2134265-2022-02382
• Device Sequence Number: 19318958
• Product Code: FGE
• UDI-Device Identifier: 08714729795285
• UDI-Public: 08714729795285
• Combination Product (Y/N): N
• Initial Reporter Country: CH
• PMA/510(K) Number: K141521
• 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,Distributor
• Initial Reporter Occupation: Physician
• Type of Report: Initial,Followup,Followup
• Report Date (Section B): 07/26/2022

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: 06/29/2024
• Device Model Number: 24674
• Device Catalogue Number: 24674
• Device Lot Number: 0027584374
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Is the Reporter a Health Professional?: Yes
• Type of Report(Section G): Initial
• Initial Date Received by Manufacturer: 02/24/2022
• Supplement Date Received by Manufacturer: 03/02/2022; 07/21/2022
• Initial Report FDA Received Date: 03/03/2022
• Supplement Report FDA Received Date: 03/09/2022; 07/26/2022
• Was Device Evaluated by Manufacturer? (Y/N): Yes
• Date Device Manufactured: 06/30/2021
• 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: 55 YR
• Patient Sex: Male
• Patient Weight: 70 KG