MAUDE Adverse Event Report: AV-TEMECULA-CT ABSOLUTE PRO VASCULAR SELF-EXPANDING STENT SYSTEM; SELF EXPANDING STENT SYSTEM

Catalog Number	1012528-60
Health Effect - Clinical Code	No Consequences Or Impact To Patient (2199)
Date of Event	09/25/2017
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
(b)(4).The device was not returned for evaluation.A review of the lot history record revealed no manufacturing nonconformities that would have contributed to this complaint.Additionally, a review of the complaint history identified no other incidents from this lot.The investigation was unable to determine a conclusive cause for the reported difficulty to deploy the thumbwheel.Based on the information reviewed, there is no indication of a product quality issue with respect to manufacture, design or labeling.The armada 35 is filed under a separate medwatch report number.
Event or Problem Description
It was reported the procedure was performed to treat a lesion in the superficial femoral artery (sfa) and the iliac vessel, both with moderate calcification.The 7x150mm armada 35 balloon dilatation catheter (bdc) was advanced to the sfa lesion without issue, but ruptured at 5 atmospheres.The bdc was removed without issue and replaced with a new armada 35 bdc.The 6.0x60mm absolute pro vascular stent delivery system (sds) was advanced to the iliac lesion.Mid-deployment, the thumbwheel jammed.The handle was cracked open, and the stent was deployed manually.There were no adverse patient effects and no clinically significant delay in the procedure.No additional information was provided.

• Brand Name: ABSOLUTE PRO VASCULAR SELF-EXPANDING STENT SYSTEM
• Common Device Name: SELF EXPANDING STENT SYSTEM
• Manufacturer (Section D): AV-TEMECULA-CT; abbott vascular; 26531 ynez road; temecula CA 92591 4628
• MDR Report Key: 6927307
• Report Number: 2024168-2017-08033
• Device Sequence Number: 461352
• Product Code: NIO
• UDI-Device Identifier: 08717648175558
• UDI-Public: 08717648175558
• Combination Product (Y/N): N
• Initial Reporter State: MA
• Initial Reporter Country: US
• PMA/510(K) Number: P110028
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2017
• Reporter Type: Manufacturer
• Report Source: company representative,health
• Initial Reporter Occupation: Health Professional
• Remedial Action: Other
• Type of Report: Initial
• Report Date (Section B): 10/06/2017

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 Expiration Date: 04/30/2020
• Device Catalogue Number: 1012528-60
• Device Lot Number: 7050461
• Was Device Available for Evaluation?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 09/27/2017
• Initial Report FDA Received Date: 10/07/2017
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1
• Outcome Attributed to Adverse Event: Required Intervention