MAUDE Adverse Event Report: BOSTON SCIENTIFIC CORPORATION OverStitch Suture Cinch; Endoscopic Tissue Approximation Device

Model Number	M00505530
Medical Device Problem Codes	Break (1069); Activation Failure (3270)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	04/28/2026
Type of Reportable Event	Serious Injury
Event or Problem Description
It was reported to boston scientific that a suture cinch was utilized in a esg- endoscopic sleeve gastroplasty procedure on (b)(6) 2026, for the treatment of obesity.During the procedure, the suture cinch was deployed and the beaded rod got reinserted/ stuck into the cinch plug.A rat tooth was utilized to hold counter tension.The procedure was completed with the original device.No patient complications were reported as a result of the event.
Additional Manufacturer Narrative
Block d4, h4: detailed product information was not provided to bsc.We completed a good faith effort to obtain the information.Because the product is unknown at this time, we are unable to provide the complete udi and other product specific information.If additional details become available, a supplemental report will be submitted.Block h6: imdrf code a150101 captures the reportable event of failure to deploy.Imdrf code a0401 captures the reportable event of cinch wire break.Imdrf code f2301 captures the reportable event of additional device required.
Event or Problem Description
It was reported to boston scientific that a suture cinch was utilized in a esg- endoscopic sleeve gastroplasty procedure on (b)(6) 2026, for the treatment of obesity.During the procedure, the suture cinch was deployed and the beaded rod got reinserted/ stuck into the cinch plug.A rat tooth was utilized to hold counter tension.The procedure was completed with the original device.No patient complications were reported as a result of the event.
Additional Manufacturer Narrative
Block d4, h4: detailed product information was not provided to bsc.We completed a good faith effort to obtain the information.Because the product is unknown at this time, we are unable to provide the complete udi and other product specific information.If additional details become available, a supplemental report will be submitted.Block h6: imdrf code a150101 captures the reportable event of failure to deploy imdrf code a0401 captures the reportable event of cinch wire break imdrf code f2301 captures the reportable event of additional device required investigation results summary the suture cinch was not returned.Therefore, a technical analysis could not be performed.The reported events could not be confirmed due to a lack of evidence.It was confirmed this device met manufacturing specification prior to distribution and there were no manufacturing deviations which could have contributed to the reported event.In reference to the event description and information provided by the customer, there is not enough evidence to determine whether the cinch failure to deploy and cinch wire break was due to the physician's technique during the procedure or was related to a device malfunction.The reported event of additional device required occurred during the procedure, and the most probable cause of this reported issue cannot be established due to lack of evidence.Based on a thorough review of the reported complaint, boston scientific has assigned an investigation conclusion code of cause not established.

• Brand Name: OverStitch Suture Cinch
• Common Device Name: Endoscopic Tissue Approximation Device
• Manufacturer (Section D): BOSTON SCIENTIFIC CORPORATION; 300 boston scientific way; marlborough MA 01752
• Manufacturer (Section G): Boston Scientific Corporation; 2546 calle primera; alajuela ; CS
• Manufacturer Contact: christina lam ; 300 boston scientific way; marlborough, MA 01752 ; +1(914)571-6918
• MDR Report Key: 25286163
• Report Number: 3005099803-2026-02107
• Device Sequence Number: 15967725
• Product Code: OCW
• UDI-Device Identifier: 00191506060046
• UDI-Public: (01)00191506060046
• Combination Product (Y/N): N
• Initial Reporter State: CA
• Initial Reporter Country: US
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2026
• Reporter Type: Manufacturer
• Report Source: Health Professional,Company Representative
• Initial Reporter Occupation: Physician
• Remedial Action: Recall
• Type of Report: Initial,Followup,Followup
• Report Date (Section B): 08/06/2026

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?: Yes
• Operator of Device: Health Professional
• Device Model Number: M00505530
• Device Catalogue Number: M00505530
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Was the Report Sent to FDA?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 04/28/2026
• Supplement Date Received by Manufacturer: 05/24/2026; 07/14/2026
• Initial Report FDA Received Date: 05/26/2026
• Supplement Report FDA Received Date: 06/18/2026; 08/06/2026
• 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
• If action reported to FDA under 21 USC 360i(g), list FDA-assigned Recall Number or include a statement: 3005099803-07142026-006R
• Patient Sequence Number: 1
• Outcome Attributed to Adverse Event: Required Intervention
• Patient Sex: Unknown