MAUDE Adverse Event Report: BOSTON SCIENTIFIC - GALWAY PROMUS PREMIER¿; STENT, CORONARY, DRUG-ELUTING

Model Number H7493925112300

Device Problem Kinked (1339)

Patient Problem No Consequences Or Impact To Patient (2199)

Event Date 05/14/2018

Event Type  malfunction  

Manufacturer Narrative

Device is a combination product.(b)(4).Device evaluated by mfr.: promus premier ous mr 3.00 x 12mm stent delivery system was returned for analysis.A visual examination of the crimped stent identified no issues.The stent showed no signs of damage or strain and was set equidistant between the proximal and distal markerbands.The crimped stent outer diameter was measured and the result was within max crimped stent profile measurement.A visual and tactile examination of the device revealed a hypotube break at 215mm distal to the distal end of the strain relief.There were multiple hypotube kinks noted.An examination of the shaft polymer extrusion revealed no issues.The bi-component bond showed no signs of damage or strain.The balloon cones were examined and no issues were noted.The balloon had not been subjected to any significant positive pressure.The tip was visually examined and no issues were noted.The investigation conclusion is operational context as the product meets the design & manufacture specification but due to anatomical/procedural factors encountered during the procedure, performance was limited.(b)(4).

Event Description

Reportable based on device analysis completed on 08jun2018.It was reported that shaft kink occurred.Vascular access was obtained via the femoral artery.The concentric target lesion contained a bend of >=90 degrees and was located in the mildly calcified proximal left circumflex artery.A 12 x 3.00mm promus premier¿ stent was advanced to treat the lesion.However, upon attempting to cross the lesion, it was noted that the mid portion of the shaft was kinked.The procedure was completed with a different stent with buddy wire support.No patient complications were reported and the patient's status was stable.However, returned device analysis revealed hypotube break.

• Brand Name: PROMUS PREMIER¿
• Type of Device: STENT, CORONARY, DRUG-ELUTING
• Manufacturer (Section D): BOSTON SCIENTIFIC - GALWAY
• Manufacturer (Section G): BOSTON SCIENTIFIC - GALWAY
• Manufacturer Contact: sonali arangil ; one scimed place; maple grove, MN 55311 ; 7634941700
• MDR Report Key: 7653054
• MDR Text Key: 112846635
• Report Number: 2134265-2018-05734
• Device Sequence Number: 1
• Product Code: NIQ
• Combination Product (y/n): N
• Reporter Country Code: IN
• PMA/PMN Number: P110010
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: company representative,foreig
• Reporter Occupation: Physician
• Type of Report: Initial
• Report Date: 06/08/2018

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 06/29/2018
• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Device Operator: Health Professional
• Device Expiration Date: 09/21/2019
• Device Model Number: H7493925112300
• Device Catalogue Number: 39251-1230
• Device Lot Number: 21186773
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 05/29/2018
• Is the Reporter a Health Professional?: Yes
• Date Manufacturer Received: 06/08/2018
• Was Device Evaluated by Manufacturer?: Yes
• Date Device Manufactured: 09/21/2017
• Is the Device Single Use?: Yes
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: Initial
• Patient Sequence Number: 1
• Patient Age: 41 YR
• Patient Weight: 65