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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: BOSTON SCIENTIFIC CORPORATION AGENT?; DRUG-ELUTING PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY CATHETER

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BOSTON SCIENTIFIC CORPORATION AGENT?; DRUG-ELUTING PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY CATHETER Back to Search Results
Model Number H7493960815250
Medical Device Problem Codes Break (1069); Material Separation (1562)
Health Effect - Clinical Code No Clinical Signs, Symptoms or Conditions (4582)
Date of Event 02/26/2026
Type of Reportable Event Malfunction
Event or Problem Description
It was reported that a shaft break occurred.An agent us mr 2.50 x 15mm was selected for treatment of the target lesion.During advancement into the sheath, the end of the catheter broke off.An alternate device was then used to successfully complete the procedure.There were no patient complications.
 
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Brand Name
AGENT?
Common Device Name
DRUG-ELUTING PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY CATHETER
Manufacturer (Section D)
BOSTON SCIENTIFIC CORPORATION
300 boston scientific way
marlborough MA 01752
Manufacturer (Section G)
FREUDENBERG MEDICAL HEMOTEQ GMBH
adenauerstrasse 15
surselen 52146
GM   52146
Manufacturer Contact
mark mischke
4100 hamline ave n
arden hills, MN 55112
7634941632
MDR Report Key24691830
Report Number2124215-2026-16439
Device Sequence Number9770669
Product Code OOB
UDI-Device Identifier00191506014735
UDI-Public(01)00191506014735
Combination Product (Y/N)Y
Initial Reporter StateIA
Initial Reporter CountryUS
PMA/510(K) Number
P230035
Number of Events Summarized1
Summary Report (Y/N)N
Serviced by Third Party (Y/N)Unknown
Reporter Type Manufacturer
Report Source Health Professional,Company Representative
Initial Reporter Occupation Physician
Type of Report Initial,Followup
Report Date (Section B) 05/27/2026
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 NumberH7493960815250
Device Catalogue NumberH7493960815250
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 02/26/2026
Supplement Date Received by Manufacturer04/29/2026
Initial Report FDA Received Date03/25/2026
Supplement Report FDA Received Date05/27/2026
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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