MAUDE Adverse Event Report: BOSTON SCIENTIFIC CORPORATION SYNERGY XD; CORONARY DRUG-ELUTING STENT

Model Number	H7493941816400
Medical Device Problem Codes	Failure to Advance (2524); Material Deformation (2976)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	03/09/2022
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
(b)(6).
Event or Problem Description
It was reported that stent damage occurred.The target lesion was located in a coronary artery.A 4.00 x 16mm synergy xd drug-eluting stent was advanced for treatment.However, during the procedure, the device was failed to cross the lesion.During removal, it was noticed the mid stent strut was sticking straight up to the center of the stent.Eventually, the device was removed intact from the patient's body and the procedure was completed with different device.There were no patient complications reported.
Additional Manufacturer Narrative
E1: initial reporter address 1: (b)(6).
Event or Problem Description
It was reported that stent damage occurred.The target lesion was located in a coronary artery.A 4.00 x 16mm synergy xd drug-eluting stent was advanced for treatment.However, during the procedure, the device was failed to cross the lesion.During removal, it was noticed the mid stent strut was sticking straight up to the center of the stent.Eventually, the device was removed intact from the patient's body and the procedure was completed with different device.There were no patient complications reported.It was further reported that the target lesion was located in the right coronary artery.
Additional Manufacturer Narrative
Device evaluated by mfr.: a synergy xd mr us 4.00 x 16mm stent delivery system was returned for analysis.A visual examination of the stent found proximal stent damage, with stent struts lifted and pulled distally.The undamaged stent outer diameter was measured and the result was within maximum crimped stent profile measurement.The balloon cones were reviewed, and no issues were noted.The balloon wings were tightly wrapped and evenly folded and were not subjected to positive pressure.A visual and microscopic examination of the bumper tip found no issues.A visual and tactile examination of the hypotube found no issues along the hypotube shaft.A visual examination of the outer and inner lumen and mid-shaft section found no issues along the shaft polymer extrusion.No other issues were identified during the product analysis.E1- initial reporter address 1: (b)(6).
Event or Problem Description
It was reported that stent damage occurred.The target lesion was located in a coronary artery.A 4.00 x 16mm synergy xd drug-eluting stent was advanced for treatment.However, during the procedure, the device was failed to cross the lesion.During removal, it was noticed the mid stent strut was sticking straight up to the center of the stent.Eventually, the device was removed intact from the patient's body and the procedure was completed with different device.There were no patient complications reported.It was further reported that the target lesion was located in the right coronary artery.

• Brand Name: SYNERGY XD
• Common Device Name: CORONARY DRUG-ELUTING STENT
• 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: 13776504
• Report Number: 2134265-2022-02959
• Device Sequence Number: 3824398
• Product Code: NIQ
• UDI-Device Identifier: 08714729981121
• UDI-Public: 08714729981121
• Combination Product (Y/N): Y
• Initial Reporter State: OH
• Initial Reporter Country: US
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): Unknown
• Reporter Type: Manufacturer
• Report Source: Health Professional,Company Representative
• Initial Reporter Occupation: Physician
• Type of Report: Initial,Followup,Followup
• Report Date (Section B): 04/29/2022

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: 07/20/2023
• Device Model Number: H7493941816400
• Device Lot Number: 0027747339
• 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: 03/09/2022
• Supplement Date Received by Manufacturer: 03/21/2022; 04/08/2022
• Initial Report FDA Received Date: 03/15/2022
• Supplement Report FDA Received Date: 03/29/2022; 04/29/2022
• Was Device Evaluated by Manufacturer? (Y/N): Yes
• Date Device Manufactured: 07/20/2021
• 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 Sex: Unknown