MAUDE Adverse Event Report: BOSTON SCIENTIFIC CORPORATION MUSTANG?; STENTS, DRAINS AND DILATORS FOR THE BILIARY DUCTS

Model Number	H74939171030870
Medical Device Problem Codes	Material Rupture (1546); Adverse Event Without Identified Device or Use Problem (2993)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	08/26/2025
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
D2b - pro code (product code): fge, lit.G4 - premarket / 510(k) #: k103751, k110122.Good faith effort attempts were made to try and retrieve additional details regarding the initial reporter address, but further information was unable to be obtained.
Event or Problem Description
It was reported that a balloon rupture occurred.The 100% stenosed target lesion was located in the arteriovenous fistula.A 3.0 x 80, 75cm mustang balloon catheter was advanced for dilation.During the procedure, the balloon ruptured.The procedure was completed with another of the same device.There were no patient complications as a result of this event.
Event or Problem Description
It was reported that a balloon rupture occurred.The 100% stenosed target lesion was located in the arteriovenous fistula.A 3.0 x 80, 75cm mustang balloon catheter was advanced for dilation.During the procedure, the balloon ruptured.The procedure was completed with another of the same device.There were no patient complications as a result of this event.It was further reported that the patient had challenging anatomy.
Additional Manufacturer Narrative
D2b - pro code (product code): fge, lit.G4 - premarket / 510(k) #: k103751, k110122.B5.Describe event or problem: added information, based on additional information good faith effort attempts were made to try and retrieve additional details regarding the initial reporter address, but further information was unable to be obtained.
Event or Problem Description
It was reported that a balloon rupture occurred.The 100% stenosed target lesion was located in the arteriovenous fistula.A 3.0 x 80, 75cm mustang balloon catheter was advanced for dilation.During the procedure, the balloon ruptured.The procedure was completed with another of the same device.There were no patient complications as a result of this event.It was further reported that the patient had challenging anatomy.
Additional Manufacturer Narrative
D2b - pro code (product code): fge, lit.G4 - premarket/510(k) #: k103751, k110122.Device evaluated by mfr: the mustang device was returned to our post market quality assurance laboratory.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 to the device, and the balloon was inflated to its rated burst pressure of 24 atmospheres with no leaks or issues noted.A visual examination of the markerbands identified no issues.A visual and tactile examination identified a shaft kink approximately 30mm distal from the distal end of the strain relief.A visual and tactile examination identified no damage to the tip.This concludes the product analysis.

• Brand Name: MUSTANG?
• Common Device Name: STENTS, DRAINS AND DILATORS FOR THE BILIARY DUCTS
• 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: 23077002
• Report Number: 2124215-2025-65416
• Device Sequence Number: 17339928
• Product Code: FGE
• UDI-Device Identifier: 08714729794950
• UDI-Public: (01)08714729794950(17)270920(10)34889997
• Combination Product (Y/N): N
• Initial Reporter Country: KS
• 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,Company Representative,Distributor
• Initial Reporter Occupation: Physician
• Type of Report: Initial,Followup,Followup
• Report Date (Section B): 12/09/2025

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 Model Number: H74939171030870
• Device Catalogue Number: H74939171030870
• Device Lot Number: 0034889997
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Is the Reporter a Health Professional?: Yes
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 08/27/2025
• Supplement Date Received by Manufacturer: 10/13/2025; 11/20/2025
• Initial Report FDA Received Date: 09/17/2025
• Supplement Report FDA Received Date: 11/03/2025; 12/09/2025
• Was Device Evaluated by Manufacturer? (Y/N): Yes
• Date Device Manufactured: 09/20/2024
• 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