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	10/06/2022
Type of Reportable Event	Malfunction
Event or Problem Description
It was reported that balloon rupture occurred.The target lesion was located in radial arteriovenous fistula.A 9.0 x 60, 75cm mustang balloon catheter was advanced for dilation.However, during inflation, the balloon burst inside the patients body.The procedure was completed with another one of the same devices.There were no patient complications reported and the patients condition was stable.
Additional Manufacturer Narrative
Updated b5: describe event or problem.
Event or Problem Description
It was reported that balloon rupture occurred.The target lesion was located in radial arteriovenous fistula.A 9.0 x 60, 75cm mustang balloon catheter was advanced for dilation.However, during inflation, the balloon burst inside the patient's body.The procedure was completed with another of same device.There were no patient complications reported, and the patient condition was stable.It was further reported that the target lesion was 70% stenosed, with a bend of >45 degrees and was severely tortuous and mildly calcified.The balloon ruptured during the second inflation at 20 atmospheres for 1 minute.Neither the balloon nor a segment of the balloon detached inside the patient after it ruptured.
Event or Problem Description
It was reported that balloon rupture occurred.The target lesion was located in radial arteriovenous fistula.A 9.0 x 60, 75cm mustang balloon catheter was advanced for dilation.However, during inflation, the balloon burst inside the patient's body.The procedure was completed with another of same device.There were no patient complications reported, and the patient condition was stable.It was further reported that the target lesion was 70% stenosed, with a bend of >45 degrees and was severely tortuous and mildly calcified.The balloon ruptured during the second inflation at 20 atmospheres for 1 minute.Neither the balloon nor a segment of the balloon detached inside the patient after it ruptured.
Additional Manufacturer Narrative
Updated b5: describe event or problem.Device evaluated by mfr.: a mustang device was received for analysis.A visual examination identified that the balloon was not folded which indicates that the balloon was subjected to positive pressure.Blood was present in balloon which is indicative of a leak.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 14mm proximal from the proximal markerband.A visual examination of the markerbands identified no issues which may potentially have contributed to the complaint incident.A visual and tactile examination identified no kinks or damage to the shaft which may have potentially contributed to the complaint incident.A visual and tactile examination identified no damage to the tip which may have potentially contributed to the complaint incident.

• 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: 15591667
• Report Number: 2124215-2022-40636
• Device Sequence Number: 16723213
• Product Code: FGE
• UDI-Device Identifier: 08714729794691
• UDI-Public: 08714729794691
• Combination Product (Y/N): N
• Initial Reporter Country: KS
• 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,Company Representative,Distributor
• Initial Reporter Occupation: Physician
• Type of Report: Initial,Followup,Followup
• Report Date (Section B): 11/16/2022

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: 12/12/2024
• Device Model Number: 24674
• Device Catalogue Number: 24674
• Device Lot Number: 0028545288
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Is the Reporter a Health Professional?: Yes
• Type of Report(Section G): Follow-Up
• Initial Date Received by Manufacturer: 10/06/2022
• Supplement Date Received by Manufacturer: 10/16/2022; 11/11/2022
• Initial Report FDA Received Date: 10/12/2022
• Supplement Report FDA Received Date: 10/18/2022; 11/16/2022
• Was Device Evaluated by Manufacturer? (Y/N): Yes
• Date Device Manufactured: 12/13/2021
• 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: 69 YR
• Patient Sex: Female