| Brand Name | ROTAPRO |
| Common Device Name | CATHETER, CORONARY, ATHERECTOMY |
| Manufacturer (Section D) |
| BOSTON SCIENTIFIC CORPORATION |
| 300 boston scientific way |
| marlborough MA 01752 |
|
| Manufacturer (Section G) |
| BOSTON SCIENTIFIC CORPORATION |
| 4100 hamline avenue north |
|
| saint paul MN 55112 5798 |
|
| Manufacturer Contact |
|
mark
mischke
|
| 4100 hamline ave n |
| arden hills, MN 55112
|
|
7634941632
|
|
| MDR Report Key | 25636482 |
| Report Number | 2124215-2026-34165 |
| Device Sequence Number | 13099616 |
| Product Code |
MCX
|
| UDI-Device Identifier | 08714729975076 |
| UDI-Public | (01)08714729975076(11)211217(10)RP005150 |
| Combination Product (Y/N) | N |
| Initial Reporter State | NV |
| Initial Reporter Country | US |
| PMA/510(K) Number | P900056/S166 |
| Number of Events Summarized | 1 |
| Summary Report (Y/N) | N |
| Serviced by Third Party (Y/N) | Unknown |
| Reporter Type |
Manufacturer
|
| Report Source |
Foreign,Company Representative |
| Initial Reporter Occupation |
Other
|
| Type of Report
| Initial |
| Report Date (Section B) |
06/26/2026 |
| 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 |
Other
|
| Device Model Number | 3256 |
| Device Catalogue Number | 3256 |
| Device Lot Number | RP005150 |
| Was Device Available for Evaluation? |
No
|
| Type of Report(Section G) | Thirty-Day |
| Initial Date Received by Manufacturer | 06/01/2026 |
| Initial Report FDA Received Date | 06/26/2026 |
| Date Device Manufactured | 12/17/2021 |
| Is the Device Labeled for Single Use? (Y/N) |
No
|
| Usage of Device |
Unknown
|
| Patient Sequence Number | 1 |
| Patient Sex | Unknown |