MAUDE Adverse Event Report: BOSTON SCIENTIFIC CORPORATION AGILE ESOPHAGEAL; PROSTHESIS, ESOPHAGEAL

Model Number	M00517250
Medical Device Problem Codes	Human-Device Interface Problem (2949); Device Stenosis (4066)
Health Effect - Clinical Code	Dysphagia/ Odynophagia (1815)
Date of Event	09/12/2023
Type of Reportable Event	Serious Injury
Event or Problem Description
Note: this report pertains to one of two devices used during the same procedure.Refer to manufacturer reports # 3005099803-2023-06204 for the associated device information.It was reported to boston scientific corporation that an agile esophageal partially covered stent was implanted in the middle esophagus to treat a malignant stricture during a stent placement procedure performed on (b)(6) 2023.The patient's anatomy was tortuous.Post stent placement, on an unknown date, the patient presented with dysphagia which prompted the physician to check the stent (the subject of this report).Stent ingrowth was observed and a second agile esophageal stent (the subject of mfr.Report # 3005099803-2023-06204) was placed on (b)(6) 2023.Prior to stent placement, the patient's anatomy was not dilated.Subsequently, on an unknown date, the patient presented again with dysphagia.The stent was checked and stent ingrowth was also observed.The physician noticed that the stent ingrowth occurred much earlier than with the wallflex esophageal stent.To restore patency, a wallflex esophageal stent was placed, and the procedure was completed.
Additional Manufacturer Narrative
Block b3: exact date is unknown, approximated based on the date the second stent was placed.Block h6: imdrf patient code e1009 captures the reportable event of dysphagia.Imdrf device code a0106 captures the reportable event of stent obstruction within device.Imdrf impact code f2301 captures the additional intervention of placing another agile stent.
Event or Problem Description
Note: this report pertains to one of two devices used during the same procedure.Refer to manufacturer reports # 3005099803-2023-06204 and 3005099803-2024-00099 for the associated device information.It was reported to boston scientific corporation that an agile esophageal partially covered stent was implanted in the middle esophagus to treat a malignant stricture during a stent placement procedure performed on (b)(6) 2023.The patient's anatomy was tortuous.Post stent placement, on an unknown date, the patient presented with dysphagia which prompted the physician to check the stent (the subject of this report).Stent ingrowth was observed and a second agile esophageal stent (the subject of mfr.Report # 3005099803-2023-06204) was placed on (b)(6) 2023.Prior to stent placement, the patient's anatomy was not dilated.Subsequently, on an unknown date, the patient presented again with dysphagia.The stent was checked and stent ingrowth was also observed.The physician noticed that the stent ingrowth occurred much earlier than with the wallflex esophageal stent.To restore patency, a wallflex esophageal stent was placed, and the procedure was completed.**additional information received on february 27, 2024** note: this report pertains to one of three devices used in the same patient.Refer to manufacturer reports # 3005099803-2023-06204, 3005099803-2024-00099, and 3005099803-2024-01133 for the associated device information.On (b)(6) 2023, the patient experienced dysphagia and was then implanted with the first agile esophageal stent (the subject of this report).However, on (b)(6) 2023, the patient again experienced dysphagia and the stent was repositioned.On (b)(6) 2023, the patient experienced dysphagia for the third time and a second agile esophageal stent (the subject of mfr.Report # 3005099803-2023-06204) was implanted.Subsequently, on (b)(6) 2023, the patient again had dysphagia and a wallflex esophageal stent (the subject of mfr.Report # 3005099803-2024-01133) was implanted.On (b)(6) 2024, the patient again presented with dysphagia and consequently, both the second agile and the wallflex esophageal stents were removed, and a non-boston scientific stent was placed stent-in-stent on the uncovered portion of the first agile esophageal stent.
Additional Manufacturer Narrative
Blocks b3, b5, and h6 (impact codes) have been updated with additional information received on february 27, 2024.Block h6: imdrf patient code e1009 captures the reportable event of dysphagia.Imdrf device code a0106 captures the reportable event of stent obstruction within device.Imdrf impact code f2301 captures the additional intervention of placing another agile stent.Imdrf impact code f2202 captures the additional endoscopic procedures.

• Brand Name: AGILE ESOPHAGEAL
• Common Device Name: PROSTHESIS, ESOPHAGEAL
• Manufacturer (Section D): BOSTON SCIENTIFIC CORPORATION; 300 boston scientific way; marlborough MA 01752
• Manufacturer (Section G): BOSTON SCIENTIFIC CORPORATION; ballybrit business park; galway ; EI
• Manufacturer Contact: carole morley ; 300 boston scientific way; marlborough, MA 01752 ; 5086834015
• MDR Report Key: 18627523
• Report Number: 3005099803-2024-00099
• Device Sequence Number: 18125338
• Product Code: ESW
• UDI-Device Identifier: 08714729972952
• UDI-Public: 08714729972952
• Combination Product (Y/N): N
• Initial Reporter Country: SN
• PMA/510(K) Number: K180144
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2023
• Serviced by Third Party (Y/N): Unknown
• Reporter Type: Manufacturer
• Report Source: Other,Foreign,Health Professional,Company Representative
• Initial Reporter Occupation: Physician
• Type of Report: Initial,Followup
• Report Date (Section B): 03/19/2024

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: Yes
• Operator of Device: Health Professional
• Device Expiration Date: 02/08/2025
• Device Model Number: M00517250
• Device Catalogue Number: 1725
• Device Lot Number: 0031016190
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Type of Report(Section G): Initial
• Initial Date Received by Manufacturer: 01/05/2024
• Supplement Date Received by Manufacturer: 02/27/2024
• Initial Report FDA Received Date: 02/01/2024
• Supplement Report FDA Received Date: 03/19/2024
• Was Device Evaluated by Manufacturer? (Y/N): Device Not Returned to Manufacturer
• Date Device Manufactured: 02/09/2023
• 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
• Outcome Attributed to Adverse Event: Required Intervention
• Patient Sex: Unknown