| Brand Name | STERLING? |
| Common Device Name | CATHETER, PERCUTANEOUS |
| Manufacturer (Section D) |
| BOSTON SCIENTIFIC CORPORATION |
| 300 boston scientific way |
| marlborough MA 01752 |
|
| Manufacturer (Section G) |
| BOSTON SCIENTIFIC CORPORATION |
| two scimed place |
|
| maple grove MN 55311 |
|
| Manufacturer Contact |
|
rachel
shields
|
| 4100 hamline ave n |
| arden hills, MN 55112
|
|
6512422111
|
|
| MDR Report Key | 23397497 |
| Report Number | 2124215-2025-76806 |
| Device Sequence Number | 21300163 |
| Product Code |
LIT
|
| UDI-Device Identifier | 08714729859581 |
| UDI-Public | (01)08714729859581(17)260212(10)31036062 |
| Combination Product (Y/N) | N |
| Initial Reporter Country | JA |
| PMA/510(K) Number | K141150 |
| 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 |
| Report Date (Section B) |
10/27/2025 |
| 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 Expiration Date | 02/12/2026 |
| Device Model Number | H74939031601110 |
| Device Catalogue Number | H74939031601110 |
| Device Lot Number | 0031036062 |
| Was Device Available for Evaluation? |
No
|
| Is the Reporter a Health Professional? |
Yes
|
| Type of Report(Section G) | Thirty-Day |
| Initial Date Received by Manufacturer | 10/02/2025 |
| Initial Report FDA Received Date | 10/27/2025 |
| Date Device Manufactured | 02/13/2023 |
| 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 |
Concomitant Medical Products and Therapy/Usage Dates | BALLOON CATHETER - SHIDEN HP 6-100; GUIDEWIRE - ASAHI INTECC CROSSLEAD TRACKER; STENT - ELUVIA 6-150,7-150 |
| Patient Sex | Unknown |
|
|