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

Catalog Number	RSINT40026UX
Medical Device Problem Code	Material Deformation (2976)
Health Effect - Clinical Code	No Consequences Or Impact To Patient (2199)
Date of Event	10/12/2018
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 integrity rx coronary drug eluting stent to treat a lesion in the mid to proximal lad.A non medtronic guide wire and a medtronic guide catheter were used in the procedure.The device did not pass through a previously deployed stent.It was reported that the stent would not cross the lesion and when removed a strut was noted to be sticking up.No patient injury was reported.
Additional Manufacturer Narrative
The stenosis was in proximal to mid lad.Device was inspected before use and the lesion was pre-dilated with a balloon.Resistance was encountered when advancing the device.If information is provided in the future, a supplemental report will be issued.
Additional Manufacturer Narrative
The stent was positioned on the balloon between the marker bands but was not meeting specification due to deformation at the proximal end.Deformation was evident to the 26th distal stent wraps with struts raised.No deformation was evident to the distal tip.The inner lumen patency was verified with a 0.015 inch mandrel.No other damage evident to the remainder of the device.If information is provided in the future, a supplemental report will be issued.

• Brand Name: RESOLUTE INTEGRITY RX
• Common Device Name: STENT, CORONARY, DRUG-ELUTING
• Manufacturer (Section D): MEDTRONIC IRELAND; parkmore business park west; galway
• MDR Report Key: 7990262
• Report Number: 9612164-2018-02858
• Device Sequence Number: 1214800
• Product Code: NIQ
• UDI-Device Identifier: 00643169037236
• UDI-Public: 00643169037236
• Combination Product (Y/N): N
• Initial Reporter State: KY
• Initial Reporter Country: US
• PMA/510(K) Number: P110013
• 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): 12/11/2018

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: 06/01/2019
• Device Catalogue Number: RSINT40026UX
• Device Lot Number: 0008658891
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 11/15/2018
• Initial Date Received by Manufacturer: 10/16/2018
• Supplement Date Received by Manufacturer: 10/22/2018; 11/23/2018
• Initial Report FDA Received Date: 10/22/2018
• Supplement Report FDA Received Date: 11/16/2018; 12/11/2018
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1
• Patient Age: 63 YR