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

Model Number	H74939171040470
Medical Device Problem Code	Material Rupture (1546)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	11/12/2025
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
D2b - pro code (product code): fge, lit.G4 - premarket / 510(k) #: k103751, k110122.The lot number was provided; however, we are unable to provide the complete unique identifier (udi) #.If additional details become available, a supplemental report will be submitted.
Event or Problem Description
It was reported that a balloon rupture occurred.The 99% stenosed target lesion was located in the moderately tortuous and moderately calcified vessel near the anastomosis site of the left internal shunt in the forearm.A 4.0 x 40, 75cm mustang balloon catheter was advanced for dilation.During the procedure, the balloon ruptured upon second inflation at 14 atmospheres.The procedure was completed with a different device.There were no patient complications as a result of this event.
Additional Manufacturer Narrative
B5 - describe event or problem updated.D4: lot number, d4.Expiration date, d4.Unique identifier (udi) and h4: device manufacture date.D2b - pro code (product code): fge, lit.G4 - premarket / 510(k) #: k103751, k110122.The lot number was provided; however, we are unable to provide the complete unique identifier (udi) #.If additional details become available, a supplemental report will be submitted.
Event or Problem Description
It was reported that a balloon rupture occurred.The 99% stenosed target lesion was located in the moderately tortuous and moderately calcified vessel near the anastomosis site of the left internal shunt in the forearm.A 4.0 x 40, 75cm mustang balloon catheter was advanced for dilation.During the procedure, the balloon ruptured upon second inflation at 14 atmospheres.The procedure was completed with a different device.There were no patient complications as a result of this event.It was further reported that the inflation time was 10 seconds before the balloon ruptured and the device was removed without any issues.

• 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: 23665293
• Report Number: 2124215-2025-87162
• Device Sequence Number: 8910227
• Product Code: FGE
• UDI-Device Identifier: 08714729793403
• UDI-Public: (01)08714729793403
• Combination Product (Y/N): N
• Initial Reporter Country: JA
• 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
• Initial Reporter Occupation: Physician
• Type of Report: Initial,Followup
• Report Date (Section B): 12/16/2025

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: H74939171040470
• Device Catalogue Number: H74939171040470
• Device Lot Number: 0036524238
• 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: 11/12/2025
• Supplement Date Received by Manufacturer: 11/25/2025
• Initial Report FDA Received Date: 11/27/2025
• Supplement Report FDA Received Date: 12/16/2025
• Date Device Manufactured: 05/15/2025
• 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: GUIDEWIRE - RADIFOCUS.; GUIDEWIRE - RADIFOCUS.; INTRODUCER SHEATH - 5FR MOSQUITO.; INTRODUCER SHEATH - 5FR MOSQUITO.
• Patient Sex: Unknown