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

Model Number	H74939206120870
Medical Device Problem Code	Material Rupture (1546)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	08/22/2025
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
D2b: pro code (product code): fge, lit.E1: initial reporter facility name: (b)(6).G4: premarket / 510(k) #: k112697, k112701, k141521.
Event or Problem Description
It was reported that balloon rupture occurred.The target lesion was located in the iliac vein.A 12.0 x80, 75cm charger balloon catheter was advanced for dilation.During the procedure, it was found that the balloon ruptured inside the patient.The procedure was completed with another of the same device.There were no patient complications as a result of this event.
Additional Manufacturer Narrative
D2b: pro code (product code): fge, lit.(b)(6).G4: premarket / 510(k) #: k112697, k112701, k141521.Device evaluated by mfr: the charger was returned for analysis.A visual examination identified that the balloon was not folded which indicates that the balloon was subjected to positive pressure.A longitudinal tear was identified in the balloon material.The tear measured approximately 90mm in length and extended from a position 3mm proximal of the proximal markerband to 6mm distal of the distal markerband.A visual examination observed no damage to the tip of the device.A visual and tactile examination of the shaft of the device found no issues.
Event or Problem Description
It was reported that balloon rupture occurred.The target lesion was located in the iliac vein.A 12.0 x80, 75cm charger balloon catheter was advanced for dilation.During the procedure, it was found that the balloon ruptured inside the patient.The procedure was completed with another of the same device.There were no patient complications as a result of this event.
Additional Manufacturer Narrative
D2b: pro code (product code): fge, lit.E1: (b)(6).Device evaluated by mfr: the charger was returned for analysis.A visual examination identified that the balloon was not folded which indicates that the balloon was subjected to positive pressure.A longitudinal tear was identified in the balloon material.The tear measured approximately 90mm in length and extended from a position 3mm proximal of the proximal markerband to 6mm distal of the distal markerband.A visual examination observed no damage to the tip of the device.A visual and tactile examination of the shaft of the device found no issues.
Event or Problem Description
It was reported that balloon rupture occurred.The target lesion was located in the iliac vein.A 12.0 x80, 75cm charger balloon catheter was advanced for dilation.During the procedure, it was found that the balloon ruptured inside the patient.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 target lesion was located in the moderately tortuous and severely calcified vein.The balloon ruptured upon second inflation.

• Brand Name: CHARGER?
• 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: 23154093
• Report Number: 2124215-2025-67575
• Device Sequence Number: 12066603
• Product Code: FGE
• UDI-Device Identifier: 08714729803881
• UDI-Public: (01)08714729803881(17)270502(10)33947139
• Combination Product (Y/N): N
• Initial Reporter Country: CH
• PMA/510(K) Number: K112697
• 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): 01/06/2026

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: H74939206120870
• Device Catalogue Number: H74939206120870
• Device Lot Number: 0033947139
• 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: 09/01/2025
• Supplement Date Received by Manufacturer: 11/18/2025; 12/14/2025
• Initial Report FDA Received Date: 09/26/2025
• Supplement Report FDA Received Date: 12/09/2025; 01/06/2026
• Was Device Evaluated by Manufacturer? (Y/N): Yes
• Date Device Manufactured: 05/02/2024
• 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: 60 YR
• Patient Sex: Male