MAUDE Adverse Event Report: BIOTRONIK AG, BUELACH, SWITZERLAND PANTERA LEO 2.5/12; BASIC CORONARY ANGIOPLASTY BALLOON CATHETER

Model Number	367004
Medical Device Problem Code	Failure to Advance (2524)
Health Effect - Clinical Code	No Consequences Or Impact To Patient (2199)
Date of Event	05/31/2019
Type of Reportable Event	Malfunction
Event or Problem Description
A pantera leo was chosen to treat a severly calcified lesion (93% stenosis degree) in a mid lad.Despite repeated attempts the device could not cross the lesion.
Additional Manufacturer Narrative
The returned instrument was subjected to a technical analysis and the corresponding production documentation was reviewed to establish whether a deviation from the manufacturing process could be the cause for the reported event.The technical investigation of the returned instrument showed that the balloon is not well folded and shows clear signs of inflation.Calculations revealed that the remaining lumen diameter in the target lesion was significantly smaller than the folded balloon profile.Review of the production documentation confirmed that the instrument was manufactured according to specifications and passed all in-process and final inspections.Based on the conducted investigations of the device subject to this complaint, no material or manufacturing related root cause could be determined.The final root cause is most likely related to patient anatomy.

• Brand Name: PANTERA LEO 2.5/12
• Common Device Name: BASIC CORONARY ANGIOPLASTY BALLOON CATHETER
• Manufacturer (Section D): BIOTRONIK AG, BUELACH, SWITZERLAND; ackerstrasse 6; buelach CH-81 80; CH CH-8180
• MDR Report Key: 8712216
• Report Number: 1028232-2019-02458
• Device Sequence Number: 2021474
• Product Code: LOX
• UDI-Device Identifier: 07640130415621
• UDI-Public: 07640130415621
• Combination Product (Y/N): N
• Initial Reporter Country: CH
• PMA/510(K) Number: K163660
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: company representative,foreig
• Initial Reporter Occupation: Other Health Care Professional
• Type of Report: Initial,Followup
• Report Date (Section B): 06/12/2019

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 Model Number: 367004
• Device Catalogue Number: SEE MODEL NO.
• Device Lot Number: 01190985
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 06/19/2019
• Initial Date Received by Manufacturer: 06/12/2019
• Supplement Date Received by Manufacturer: 08/16/2019
• Initial Report FDA Received Date: 06/19/2019
• Supplement Report FDA Received Date: 08/21/2019
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1