MAUDE Adverse Event Report: MEDTRONIC IRELAND RESOLUTE ONYX RX; STENT, CORONARY, DRUG-ELUTING

Catalog Number	RONYX27522UX
Medical Device Problem Code	Material Deformation (2976)
Health Effect - Clinical Code	No Consequences Or Impact To Patient (2199)
Date of Event	03/01/2018
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
If information is provided in the future, a supplemental report will be issued.
Event or Problem Description
It was reported that the physician intended to use resolute onyx drug eluting stent to treat a mildly tortuous and moderately calcified lesion located in the proximal right coronary artery, exhibiting 90% stenosis.There were no abnormalities reported in relation to anatomy.There was no damage noted to packaging.There were no issues noted when removing the device from the hoop/tray.The device was inspected with no issues identified.Negative prep was performed with no issues noted.The lesion was pre-dilated.The device did not pass through a previously-deployed stent.Excessive force was not used during delivery.It was reported that the stent was placed through the guide liner and physician felt resistance as the stent was passing through the calcified lesion.Physician decided to take the stent out and they noticed that the stent was damaged.Patient status post-procedure is alive with no injury.
Additional Manufacturer Narrative
Evaluation summary: numerous kinks were visible along the hypotube during analysis.The stent was positioned on the balloon between the marker bands as per specifications.Deformation was evident to the 11th, 12th, 16th and 17th stent wraps, with struts raised.Deformation was evident to the distal tip, with tip appearing kinked.The guidewire lumen patency was verified with a 0.015 inch mandrel.A kink was evident along the stent/distal shaft, 2.2cm proximal to the distal tip.If information is provided in the future, a supplemental report will be issued.
Additional Manufacturer Narrative
If information is provided in the future, a supplemental report will be issued.

• Brand Name: RESOLUTE ONYX RX
• Common Device Name: STENT, CORONARY, DRUG-ELUTING
• Manufacturer (Section D): MEDTRONIC IRELAND; parkmore business park west; galway
• MDR Report Key: 7372598
• Report Number: 9612164-2018-00572
• Device Sequence Number: 19122927
• Product Code: NIQ
• UDI-Device Identifier: 00643169556911
• UDI-Public: 00643169556911
• Combination Product (Y/N): N
• Initial Reporter State: CA
• Initial Reporter Country: US
• PMA/510(K) Number: P160043
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: company representative,health
• Initial Reporter Occupation: Physician
• Type of Report: Initial,Followup,Followup
• Report Date (Section B): 06/29/2018

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 Expiration Date: 10/01/2019
• Device Catalogue Number: RONYX27522UX
• Device Lot Number: 0008817860
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 03/20/2018
• Initial Date Received by Manufacturer: 03/01/2018
• Supplement Date Received by Manufacturer: 04/03/2018; 05/31/2018
• Initial Report FDA Received Date: 03/27/2018
• Supplement Report FDA Received Date: 05/01/2018; 06/29/2018
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1