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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: BOSTON SCIENTIFIC CORPORATION SYNERGY? XD; CORONARY DRUG-ELUTING STENT

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BOSTON SCIENTIFIC CORPORATION SYNERGY? XD; CORONARY DRUG-ELUTING STENT Back to Search Results
Model Number H7493941832400
Medical Device Problem Code Break (1069)
Health Effect - Clinical Code No Clinical Signs, Symptoms or Conditions (4582)
Date of Event 01/20/2026
Type of Reportable Event Malfunction
Additional Manufacturer Narrative
Good faith effort attempts were made to try and retrieve additional details regarding the reported event, but further information was unable to be obtained.
 
Event or Problem Description
It was reported that shaft break occurred.The patient presented with coronary artery disease and underwent percutaneous coronary intervention.A 4.00 x 32mm synergy? xd drug-eluting stent was advanced for treatment.However, during delivery, the device was fractured.The procedure was completed and there were no complications reported post-procedure.
 
Additional Manufacturer Narrative
Good faith effort attempts were made to try and retrieve additional details regarding the reported event, but further information was unable to be obtained.Investigation results: device analysis findings: the device was discarded and will not be returned; therefore, a technical analysis could not be performed.Device history record review: it was confirmed that this device met manufacturing specification prior to distribution and there no manufacturing deviations which could have contributed to the reported event.Labeling review: review of the instructions for use (ifu) confirmed there was relevant content and sufficient guidance with respect to the circumstances described within this complaint.No updates are required to the ifu as a result of this event.Risk review: a risk review was performed, and it confirmed that the event was defined in the risk documentation.This event type has been accounted for during product risk analysis to support acceptable risk benefit for the product.Investigation conclusion: this investigation is assigned a most probable investigation conclusion code of cause not established.This conclusion code is based on the event description and lack of information provided.It was reported that shaft break occurred.No additional information from the event was received and the device was not returned for analysis therefore reported allegation could not be confirmed.Based on the event details and considering the device was not returned for analysis it was not possible to determine whether procedural technique, patient anatomy or another factor contributed to the reported allegation of shaft break.As a result, a clear cause for the event cannot be determined with certainty based on the available information.
 
Event or Problem Description
It was reported that shaft break occurred.The patient presented with coronary artery disease and underwent percutaneous coronary intervention.A 4.00 x 32mm synergy? xd drug-eluting stent was advanced for treatment.However, during delivery, the device was fractured.The procedure was completed and there were no complications reported post-procedure.
 
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Brand Name
SYNERGY? XD
Common Device Name
CORONARY DRUG-ELUTING STENT
Manufacturer (Section D)
BOSTON SCIENTIFIC CORPORATION
300 boston scientific way
marlborough MA 01752
Manufacturer (Section G)
BOSTON SCIENTIFIC CORPORATION
ballybrit business park
galway
EI  
Manufacturer Contact
mark mischke
4100 hamline ave n
arden hills, MN 55112
7634941632
MDR Report Key24272623
Report Number2124215-2026-06711
Device Sequence Number16133182
Product Code NIQ
UDI-Device Identifier08714729981169
UDI-Public(01)08714729981169(17)270414(10)36356989
Combination Product (Y/N)Y
Initial Reporter StateSD
Initial Reporter CountryUS
PMA/510(K) Number
P150003
Number of Events Summarized1
Summary Report (Y/N)N
Serviced by Third Party (Y/N)Unknown
Reporter Type Manufacturer
Report Source Company Representative
Initial Reporter Occupation Non-Healthcare Professional
Type of Report Initial,Followup
Report Date (Section B) 04/17/2026
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 NumberH7493941832400
Device Catalogue NumberH7493941832400
Device Lot Number0036356989
Was Device Available for Evaluation? No
Type of Report(Section G)Thirty-Day
Initial Date Received by Manufacturer 01/20/2026
Supplement Date Received by Manufacturer04/03/2026
Initial Report FDA Received Date02/05/2026
Supplement Report FDA Received Date04/17/2026
Date Device Manufactured04/14/2025
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 Number1
Patient SexUnknown
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