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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: BOSTON SCIENTIFIC CORPORATION MUSTANG?; stents, drains and dilators for the biliary ducts

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BOSTON SCIENTIFIC CORPORATION MUSTANG?; stents, drains and dilators for the biliary ducts Back to Search Results
Model Number H74939171040470
Medical Device Problem Code Material Rupture (1546)
Health Effect - Clinical Code No Clinical Signs, Symptoms or Conditions (4582)
Date of Event 07/22/2026
Type of Reportable Event Malfunction
Event or Problem Description
It was reported that balloon rupture occurred.The target lesion was located in severely calcified superficial femoral artery.A 4.0 x 40, 75cm mustang balloon was advanced for dilation.During the procedure, the balloon rupture upon first inflation at 10 atmospheres.The device was removed without any problem, and the procedure was completed with another of the same device.There were no patient complications as a result of this event.
 
Additional Manufacturer Narrative
E1: initial reporter city: (b)(6).D2b: pro code (product code): fge, lit.G4: premarket / 510(k) #: k103751, k110122.
 
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Brand Name
MUSTANG?
Common Device Name
stents, drains and dilators for the biliary ducts
Manufacturer (Section D)
BOSTON SCIENTIFIC CORPORATION
300 boston scientific way
marlborough MA 01752
Manufacturer (Section G)
Boston Scientific Corporation
pmt 741 persiaran cassia selat
bandarcassia, pulau pinan 14110
MY   14110
Manufacturer Contact
mark mischke
4100 hamline ave n
arden hills, MN 55112
+1(763)494-1632
MDR Report Key50290600
Report Number2124215-2026-44220
Device Sequence Number21256351
Product Code FGE
UDI-Device Identifier08714729793403
UDI-Public(01)08714729793403(17)290129(10)38475859
Combination Product (Y/N)N
Initial Reporter CountryJA
PMA/510(K) Number
K103751
Number of Events Summarized1
Summary Report (Y/N)N
Reporter Type Manufacturer
Report Source Other,Foreign,Health Professional,Company Representative,Distributor
Initial Reporter Occupation Physician
Type of Report Initial
Report Date (Section B) 08/17/2026
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 NumberH74939171040470
Device Catalogue NumberH74939171040470
Device Lot Number0038475859
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 07/23/2026
Initial Report FDA Received Date08/18/2026
Date Device Manufactured01/30/2026
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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