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	08/17/2023
Type of Reportable Event	Malfunction
Event or Problem Description
It was reported that balloon rupture occurred.The target lesion was located in the arteriovenous fistula junction.A 3.0 x 40, 75cm mustang balloon catheter was advanced for dilatation.However, before it was inflated to the nominal bar, the balloon burst.The procedure was completed with another of the same device.There were no patient complications reported and the patient status was stable.
Additional Manufacturer Narrative
A2 - age at time of event: patient is 18 years or older.
Additional Manufacturer Narrative
A2 - age at time of event: patient is 18 years or older.B5 - describe event or problem: updated to include new information obtained.
Event or Problem Description
It was reported that balloon rupture occurred.The target lesion was located in the arteriovenous fistula junction.A 3.0 x 40, 75cm mustang balloon catheter was advanced for dilatation.However, before it was inflated to the nominal bar, the balloon burst.The procedure was completed with another of the same device.There were no patient complications reported and the patient status was stable.It was further reported that the target lesion was 90% stenosed and located in the moderately tortuous and moderately calcified arteriovenous fistula junction.The balloon burst during the first inflation at 4 bar.The balloon was deflated and slowly removed from the patient.
Event or Problem Description
It was reported that balloon rupture occurred.The target lesion was located in the arteriovenous fistula junction.A 3.0 x 40, 75cm mustang balloon catheter was advanced for dilatation.However, before it was inflated to the nominal bar, the balloon burst.The procedure was completed with another of the same device.There were no patient complications reported and the patient status was stable.It was further reported that the target lesion was 90% stenosed and located in the moderately tortuous and moderately calcified arteriovenous fistula junction.The balloon burst during the first inflation at 4 bar.The balloon was deflated and slowly removed from the patient.
Additional Manufacturer Narrative
A2 - age at time of event: patient is 18 years or older.B5 - describe event or problem: updated to include new information obtained.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.The rated burst pressure for this device is 24 atmospheres as per mustang 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 18mm proximal from the distal markerband.A visual examination of the markerbands identified no issues.A visual and tactile examination identified no kinks or damage to the shaft.A visual and tactile examination identified no damage to the tip.This concludes the product analysis.

• Brand Name: MUSTANG
• Common Device Name: CATHETER, BILIARY, DIAGNOSTIC
• Manufacturer (Section D): BOSTON SCIENTIFIC CORPORATION; 300 boston scientific way; marlborough MA 01752
• Manufacturer (Section G): BOSTON SCIENTIFIC CORPORATION; pmt 741 persiaran cassia selat; bandarcassia, pulau pinan 14110 ; MY 14110
• Manufacturer Contact: rachel shields ; 4100 hamline ave n; arden hills, MN 55112 ; 6512422111
• MDR Report Key: 17651840
• Report Number: 2124215-2023-46171
• Device Sequence Number: 7371146
• Product Code: FGE
• UDI-Device Identifier: 08714729793946
• UDI-Public: 08714729793946
• Combination Product (Y/N): N
• Initial Reporter Country: TW
• PMA/510(K) Number: K103751
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): Unknown
• Reporter Type: Manufacturer
• Report Source: Other,Foreign,Health Professional,Distributor
• Initial Reporter Occupation: Physician
• Type of Report: Initial,Followup,Followup
• Report Date (Section B): 09/18/2023

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: 11/28/2025
• Device Model Number: 24674
• Device Catalogue Number: 24674
• Device Lot Number: 0030614860
• 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: 08/23/2023
• Supplement Date Received by Manufacturer: 09/03/2023; 09/14/2023
• Initial Report FDA Received Date: 08/30/2023
• Supplement Report FDA Received Date: 09/07/2023; 09/18/2023
• Was Device Evaluated by Manufacturer? (Y/N): Yes
• Date Device Manufactured: 11/29/2022
• 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