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

Catalog Number	RONYX27534UX
Medical Device Problem Code	Material Deformation (2976)
Health Effect - Clinical Code	No Consequences Or Impact To Patient (2199)
Date of Event	05/03/2018
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
During the procedure, an attempt was made to use one resolute onyx drug eluting stent to treat a mildly tortuous and moderately calcified lesion, located in the mid left anterior descending artery, exhibiting 80% stenosis.There were no abnormalities 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 device did pass through a previously-deployed stent.Resistance was encountered when advancing the device.Excessive force was not used during delivery.It was reported that an attempt was made to advance the device but it was not possible to get to the desired location.The device was removed and it was noted that the end of the stent was frayed.Patient status post-procedure is alive with no injury.The procedure was completed with another resolute onyx device (ronyx27522ux).
Additional Manufacturer Narrative
Device evaluation summary: the stent was not positioned on the balloon between the marker bands as per specifications.Deformation was evident to the 33rd and 34th stent wraps with struts raised and bunched, and misalignment was evident to the 1st stent wrap with the struts raised.No deformation was evident 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: 7548085
• Report Number: 9612164-2018-01252
• Device Sequence Number: 167680
• Product Code: NIQ
• UDI-Device Identifier: 00643169556942
• UDI-Public: 00643169556942
• 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,foreig
• Initial Reporter Occupation: Physician
• Type of Report: Initial,Followup,Followup
• Report Date (Section B): 10/18/2018

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: 11/06/2019
• Device Catalogue Number: RONYX27534UX
• Device Lot Number: 0008843698
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 05/30/2018
• Initial Date Received by Manufacturer: 05/04/2018
• Supplement Date Received by Manufacturer: 08/23/2018; 10/12/2018
• Initial Report FDA Received Date: 05/29/2018
• Supplement Report FDA Received Date: 09/20/2018; 10/18/2018
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1