MAUDE Adverse Event Report: LUTONIX, INC Lutonix 035AV Drug Coated PTA Dilation Catheter; Drug Coated Balloon PTA Catheter

Model Number	9010
Medical Device Problem Code	Adverse Event Without Identified Device or Use Problem (2993)
Health Effect - Clinical Codes	Hemorrhage/Blood Loss/Bleeding (1888); Restenosis (4576); Insufficient Information (4580)
Date of Event	11/01/2024
Type of Reportable Event	Death
Event or Problem Description
It was reported through the results of a clinical trial that approximately four years, three months and three days post an index procedure completion using a drug-coated balloon catheter, the subject had an adverse event of intermittent prolonged bleeding after dialysis.Sometime later the subject passed away and cause of death was not provided.The causal relationship was not provided.
Additional Manufacturer Narrative
H10: date of death for this patient was not provided, date of death updated as (b)(6) 1900 for the mdr submission requirement.H10: as the lot number for the device was provided, a review of the device history records will be performed.The sample was not returned to the manufacturer for inspection/evaluation.Therefore, the investigation of the reported event is inconclusive.Based upon the available information, the definitive root cause for this event is unknown.The instructions for use (ifu) is adequate for the reported device/patient code(s) and provides general instructions for use, as well as warnings, precautions and potential complications associated with the device.Upon receipt of new or additional information, a follow-up report will be submitted as applicable.H11: section a through f ¿ the information provided by bd represents all the known information at this time.Despite good faith efforts to obtain additional information, the complainant/reporter was unable or unwilling to provide any further patient, product, or procedural details to bd.
Event or Problem Description
It was reported through the results of a clinical trial that approximately one year two months and twenty-four days post an index procedure completion using a drug-coated balloon catheter for cephalic vein stenosis, the subject had an adverse event of intermittent prolonged bleeding after dialysis.Reportedly, the adverse event was possibly related to study device and procedure but not related to av access circuit.It was further reported that approximately six months six days post index procedure, the subject underwent av access circuit re-intervention for prolonged bleeding.A standard percutaneous transluminal angioplasty was used in re-intervention for target lesion on cephalic vein with initial stenosis of 50% and final residual stenosis of 0%.
Additional Manufacturer Narrative
H10: manufacturing review: the device history records have been reviewed and this lot met all release criteria.Investigation summary: the physical device was not returned for evaluation.No photos were provided for review.Therefore, the investigation is inconclusive for the reported failure as no objective evidence was provided for review.Based upon the available information, the definitive root cause is unknown.Labeling review: as the reported event did not allege a labeling or use related issue, a labeling review is not required.H11: b2, b5, d4 (unique device identifier (udi) #), h1, h6 (patient, method).H11: section a through f - the information provided by bd represents all of the known information at this time.Despite good faith efforts to obtain additional information, the complainant / reporter was unable or unwilling to provide any further patient, product, or procedural details to bd.
Event or Problem Description
It was reported through the results of a clinical trial that approximately one year, two months and twenty four days post an index procedure completion using a drug coated balloon catheter for cephalic vein stenosis, the subject had an adverse event of intermittent prolonged bleeding after dialysis.Reportedly, the adverse event was possibly related to study device and procedure but not related to av access circuit.It was further reported that approximately six months and six days post an index procedure, the subject underwent av access circuit re-intervention for prolonged bleeding.A standard percutaneous transluminal angioplasty was used in re-intervention for target lesion on cephalic vein with initial stenosis of 50 percent and final residual stenosis of 0 percent.
Additional Manufacturer Narrative
H11: manufacturing review: the device history records have been reviewed and this lot met all release criteria.Investigation summary: the physical device was not returned for evaluation.No photos were provided for review.Therefore, the investigation is inconclusive for the reported failure as no objective evidence was provided for review.Based upon the available information, the definitive root cause is unknown.Labeling review: as the reported event did not allege a labeling or use related issue, a labeling review is not required.B1, d3, d4 (medical device model #), g3, h6 (patient, component).Section a through f: the information provided by bd represents all the known information at this time.Despite good faith efforts to obtain additional information, the complainant/reporter was unable or unwilling to provide any further patient, product, or procedural details to bd.

• Brand Name: Lutonix 035AV Drug Coated PTA Dilation Catheter
• Common Device Name: Drug Coated Balloon PTA Catheter
• Manufacturer (Section D): LUTONIX, INC; 9409 science center dr; new hope MN 55428
• Manufacturer (Section G): C.R. Bard, Inc. (GFO); 289 bay road; queensbury 12804
• Manufacturer Contact: michael gaffney ; 800 w. rio salado pkwy; tempe, AZ 85281 ; +1(480)303-2689
• MDR Report Key: 21419169
• Report Number: 3006513822-2025-00008
• Device Sequence Number: 20770240
• Product Code: PRC
• UDI-Device Identifier: 00801741135491
• UDI-Public: (01)00801741135491(11)231122(17)251009(10)GFHX0825
• Combination Product (Y/N): Y
• Initial Reporter State: MI
• Initial Reporter Country: US
• PMA/510(K) Number: P170003
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: Other,Study
• Initial Reporter Occupation: Physician
• Type of Report: Initial,Followup,Followup
• Report Date (Section B): 09/23/2026

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?: No
• Operator of Device: Health Professional
• Device Expiration Date: 10/09/2025
• Device Model Number: 9010
• Device Catalogue Number: LX3575960V
• Device Lot Number: GFHX0825
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Was the Report Sent to FDA?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 02/04/2025
• Supplement Date Received by Manufacturer: 04/04/2025; 09/23/2026
• Initial Report FDA Received Date: 02/20/2025
• Supplement Report FDA Received Date: 05/04/2025; 09/25/2026
• Was Device Evaluated by Manufacturer? (Y/N): No
• Date Device Manufactured: 11/22/2023
• 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; Life Threatening; Hospitalization; Death
• Patient Age: 54 YR
• Patient Sex: Male
• Patient Race: Black Or African American