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

Catalog Number	RONYX27508UX
Medical Device Problem Code	Use of Device Problem (1670)
Health Effect - Clinical Code	No Consequences Or Impact To Patient (2199)
Date of Event	08/29/2019
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 a procedure a resolute onyx rx coronary drug eluting stent was used to treat a lesion.There was no damage noted to the packaging and no issues noted when removing from the hoop.The device did not pass through a previously deployed stent.No resistance was encountered when advancing the device and excessive force was not used.It was reported that post implantation of the stent, it was noted to have expired four days previous.The patient was reported to be alive with no injury.(quarterly scan was performed last quarter and was scheduled for next week for q2.Account inventory personnel asks that product not be pulled from shelf during quarterly scans unless less than 30 days is left until use by date.Account inventory personnel has voiced that hospital staff pulls products on a consistent basis to return to vendors for replacement.According to the ohsu director of operations and finance, the patient will not be charged for the stent.Account has limited lab access for vendors).
Additional Manufacturer Narrative
If information is provided in the future, a supplemental report will be issued.
Additional Manufacturer Narrative
The expiration date was not checked prior to use.No patient injury or medical/surgical intervention was required as a result of the event.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: 8959286
• Report Number: 9612164-2019-03736
• Device Sequence Number: 11434885
• Product Code: NIQ
• UDI-Device Identifier: 00643169556874
• UDI-Public: 00643169556874
• Combination Product (Y/N): N
• Initial Reporter State: OR
• Initial Reporter Country: US
• PMA/510(K) Number: P160043
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2019
• Reporter Type: Manufacturer
• Report Source: company representative,health
• Initial Reporter Occupation: Physician
• Type of Report: Initial,Followup,Followup
• Report Date (Section B): 10/31/2019

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 Expiration Date: 08/25/2019
• Device Catalogue Number: RONYX27508UX
• Device Lot Number: 0008768974
• Was Device Available for Evaluation?: No
• Initial Date Received by Manufacturer: 08/29/2019
• Supplement Date Received by Manufacturer: 09/04/2019; 10/25/2019
• Initial Report FDA Received Date: 09/04/2019
• Supplement Report FDA Received Date: 09/25/2019; 10/31/2019
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1