| Brand Name | VersaCross Connect Access Solution for FARADRIVE |
| Common Device Name | Catheter, Septostomy |
| Manufacturer (Section D) |
| BOSTON SCIENTIFIC CORPORATION |
| 300 boston scientific way |
| marlborough MA 01752 |
|
| Manufacturer (Section G) |
| Boston Scientific Corporation |
| multitenant #2, street #58 zon |
|
| cartago, 03 30106 |
|
CS
30106
|
|
| Manufacturer Contact |
|
mary
crawford
|
| 4100 hamline avenue north |
| dc a330 |
| saint paul, MN 55112
|
|
+1(651)440-0979
|
|
| MDR Report Key | 50399362 |
| Report Number | 2124215-2026-45287 |
| Device Sequence Number | 13375647 |
| Product Code |
DXF
|
| UDI-Device Identifier | 00685447019046 |
| Combination Product (Y/N) | N |
| Initial Reporter Country | CA |
| PMA/510(K) Number | K150709 |
| Number of Events Summarized | 1 |
| Summary Report (Y/N) | N |
| Reporter Type |
Manufacturer
|
| Report Source |
Other,Foreign,Health Professional,Company Representative |
| Initial Reporter Occupation |
Physician
|
| Type of Report
| Initial,Followup |
| Report Date (Section B) |
09/21/2026 |
| 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 Number | VXAK0041 |
| Device Catalogue Number | VXAK0041 |
| Device Lot Number | 0039560215 |
| 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 | Not provided |
| Supplement Date Received by Manufacturer | 08/27/2026
|
| Initial Report FDA Received Date | 08/24/2026 |
| Supplement Report FDA Received Date | 09/21/2026
|
| Date Device Manufactured | 05/12/2026 |
| Is the Device Labeled for Single Use? (Y/N) |
Yes
|
| Usage of Device |
Initial
|
| Patient Sequence Number | 1 |
| Patient Sex | Unknown |
|
|