MAUDE Adverse Event Report: ANGIODYNAMICS, INC. XCELA; PORT & CATHETER, IMPLANTED, SUBCUTANEOUS, INTRAVASCULAR

Model Number	H965440400
Medical Device Problem Code	Adverse Event Without Identified Device or Use Problem (2993)
Health Effect - Clinical Codes	Pulmonary Embolism (1498); Chest Pain (1776); Thrombosis/Thrombus (4440)
Date of Event	12/18/2023
Type of Reportable Event	Serious Injury
Event or Problem Description
On or about on (b)(6) 2023, plaintiff underwent placement of an angiodynamics xcela port product, reference number: h965440400, lot number: 5795892.The device was implanted by (b)(6), do, at (b)(6), for chemotherapy administration.On or about on (b)(6) 2023, plaintiff presented to (b)(6) center with chest pains.As a result, a doppler ultrasound was ordered and later showed a thrombosis at or near the right internal jugular, subclavian, axillary, and/or brachial veins.On or about on (b)(6) 2024, plaintiff was diagnosed with a pulmonary embolus following a ct scan.On or about on (b)(6) 2024, plaintiff's port was removed by dr.(b)(6), md at (b)(6) center.
Additional Manufacturer Narrative
The device is not available to be returned to the manufacturer for evaluation.An investigation into the root cause for the event is currently in progress.The results of the investigation will be sent via a follow up medwatch.Reference: (b)(4).
Additional Manufacturer Narrative
The customer's reported complaint description of patient thrombosis/pe cannot be confirmed given the patient centric nature of this serious adverse event (sae).No port device was returned for evaluation.In addition, there was no report of port/catheter device malfunction, damage or performance issue during device use.A device history record (dhr) review of the indicated packaging lot revealed no quality related issues or manufacturing deficiencies at the time of manufacture.There have been no other reported complaints for the indicated packaging lot for similar thrombosis issue.Labeling review: the direction for use (dfu) that is provided with the port device contains the following statements: contraindications · presence of infection, bacteremia, septicemia or peritonitis.Warnings · the device is to be implanted, used, maintained, and removed in strict accordance with institutional and or centers for disease control (cdc) guidelines or policies.Precautions · carefully read and follow all instructions prior to use.· after implantation and after any treatment via the port, the system should be flushed with normal saline for injection per institutional protocol · if more than one drug is to be administered, between the individual drug applications, flush the system with 5 to 10 ml normal saline for injection to prevent drug interactions · after any infusion, injection or bolus application, the system should be flushed with normal saline for injection or locked with a heparin solution per institutional protocol to prevent thrombotic occlusion of the catheter.Bioflo ports with the pasv valve may be locked with either normal saline or heparinized saline per institutional protocol adverse events · bacteremia · catheter thrombosis · inflammation · infection · implantation site necrosis or infection · thromboembolism · thrombophlebitis · tunnel infection maintenance to help prevent clot formation and catheter blockage, the xcela plus port should be filled with sterile heparinized saline after each use.Xcela plus ports with the pasv valve may be flushed and locked with either normal saline or heparinized saline per institutional protocol.If the port remains unused for long periods of time, the lock should be changed at least once every four weeks.A review of the angiodynamics complaint system noted no adverse trends for this complaint type and product family.This type of complaint continues to be monitored for trends.Reference (b)(4).

• Brand Name: XCELA
• Common Device Name: PORT & CATHETER, IMPLANTED, SUBCUTANEOUS, INTRAVASCULAR
• Manufacturer (Section D): ANGIODYNAMICS, INC.; 603 queensbury avenue; queensbury NY 12804
• Manufacturer (Section G): ANGIODYNAMICS, INC.; 603 queensbury avenue; queensbury NY 12804
• Manufacturer Contact: alexandra invencio ; 26 forest street; marlborough, MA 01752
• MDR Report Key: 23831256
• Report Number: 1319211-2025-00061
• Device Sequence Number: 15711010
• Product Code: LJT
• UDI-Device Identifier: 15051684018883
• UDI-Public: 15051684018883
• Combination Product (Y/N): N
• Initial Reporter State: FL
• Initial Reporter Country: US
• PMA/510(K) Number: K153228
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2023
• Device Explanted Year: 2024
• Serviced by Third Party (Y/N): Unknown
• Reporter Type: Manufacturer
• Report Source: Other,Company Representative
• Initial Reporter Occupation: Non-Healthcare Professional
• Type of Report: Initial,Followup
• Report Date (Section B): 02/27/2026

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: 07/31/2025
• Device Model Number: H965440400
• Device Catalogue Number: 44040
• Device Lot Number: 5795892
• Was Device Available for Evaluation?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 12/05/2025
• Supplement Date Received by Manufacturer: 02/20/2026
• Initial Report FDA Received Date: 12/17/2025
• Supplement Report FDA Received Date: 02/27/2026
• Was Device Evaluated by Manufacturer? (Y/N): No
• Date Device Manufactured: 08/29/2023
• 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: Reuse
• Patient Sequence Number: 1
• Outcome Attributed to Adverse Event: Required Intervention; Hospitalization; Life Threatening; Other
• Patient Sex: Female