MAUDE Adverse Event Report: BOSTON SCIENTIFIC CORPORATION STERLING; CATHETER, PERCUTANEOUS

Model Number	24700
Medical Device Problem Code	Material Rupture (1546)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	06/07/2023
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
E1: initial reporter phone number: (b)(6).
Event or Problem Description
It was reported, that balloon rupture occurred.The 90% stenosed target lesion was located in the subclavian artery.A 4.0mmx40mmx80cm (4f) sterling balloon catheter was advanced for dilation.However, during inflation at nominal burst pressure, the balloon ruptured.The procedure was completed with another of the same device.No patient complications were reported.And the patient condition was stable.
Event or Problem Description
It was reported that balloon rupture occurred.The 90% stenosed target lesion was located in the subclavian artery.A 4.0mmx40mmx80cm (4f) sterling balloon catheter was advanced for dilation.However, during inflation at nominal burst pressure, the balloon ruptured.The procedure was completed with another of the same device.No patient complications were reported and the patient condition was stable.It was further reported that the target lesion was mildly tortuous.The balloon ruptured on the first inflation and was completely removed from the patient.
Additional Manufacturer Narrative
E1: initial reporter phone number: (b)(6).
Event or Problem Description
It was reported that balloon rupture occurred.The 90% stenosed target lesion was located in the subclavian artery.A 4.0mmx40mmx80cm (4f) sterling balloon catheter was advanced for dilation.However, during inflation at nominal burst pressure, the balloon ruptured.The procedure was completed with another of the same device.No patient complications were reported and the patient condition was stable.It was further reported that the target lesion was mildly tortuous.The balloon ruptured on the first inflation and was completely removed from the patient.
Additional Manufacturer Narrative
E1: initial reporter phone number: (b)(6).Device evaluated by mfr: returned product consisted of a sterling balloon catheter.The outer shaft, inner shaft, balloon and tip were visually and microscopically examined.Visual examination revealed a longitudinal tear in the balloon 5mm from the tip and is approximately 40mm long.Microscopic examination revealed no additional damages.Inspection of the remainder of the device presented no other damage or irregularities.

• Brand Name: STERLING
• Common Device Name: CATHETER, PERCUTANEOUS
• Manufacturer (Section D): BOSTON SCIENTIFIC CORPORATION; 300 boston scientific way; marlborough MA 01752
• Manufacturer (Section G): BOSTON SCIENTIFIC CORPORATION; two scimed place; maple grove MN 55311
• Manufacturer Contact: rachel shields ; 4100 hamline ave n; arden hills, MN 55112 ; 6512422111
• MDR Report Key: 17175177
• Report Number: 2124215-2023-32245
• Device Sequence Number: 17414826
• Product Code: DQY
• UDI-Device Identifier: 08714729123637
• UDI-Public: 08714729123637
• Combination Product (Y/N): N
• Initial Reporter Country: TW
• PMA/510(K) Number: K053116
• 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): 08/16/2023

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: 10/19/2025
• Device Model Number: 24700
• Device Catalogue Number: 24700
• Device Lot Number: 0030386899
• 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: 06/09/2023
• Supplement Date Received by Manufacturer: 06/16/2023; 08/09/2023
• Initial Report FDA Received Date: 06/21/2023
• Supplement Report FDA Received Date: 06/27/2023; 08/16/2023
• Was Device Evaluated by Manufacturer? (Y/N): Yes
• Date Device Manufactured: 10/20/2022
• 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