| Brand Name | Jagwire |
| Common Device Name | Endoscopic Guidewire, Gastroenterology-Urology |
| 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 | 50744400 |
| Report Number | 3005099803-2026-03736 |
| Device Sequence Number | 8541902 |
| Product Code |
OCY
|
| UDI-Device Identifier | 08714729339151 |
| UDI-Public | (01)08714729339151(17)280922(10)37528609 |
| Combination Product (Y/N) | N |
| Initial Reporter Country | CH |
| PMA/510(K) Number | K141820 |
| Number of Events Summarized | 1 |
| 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) |
09/11/2026 |
| 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 | M00556581 |
| Device Catalogue Number | M00556581 |
| Device Lot Number | 0037528609 |
| 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 | 08/17/2026 |
| Initial Report FDA Received Date | 09/11/2026 |
| Date Device Manufactured | 09/23/2025 |
| 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 Number | 1 |
| Patient Age | 70 YR |
| Patient Sex | Female |
| Patient Weight | 127 LB |
|
|