MAUDE Adverse Event Report: BOSTON SCIENTIFIC CORPORATION QUANTUM MAVERICK; CATHETERS, TRANSLUMINAL CORONARY ANGIOPLASTY, PERCUTANEOUS

Model Number	7010
Medical Device Problem Code	Material Rupture (1546)
Health Effect - Clinical Code	No Consequences Or Impact To Patient (2199)
Date of Event	03/13/2020
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
(b)(6).
Event or Problem Description
It was reported that balloon rupture occurred.The 88% stenosed, 28-32mmx4.0-4.5mm target lesion was located in the moderately tortuous and severely calcified left anterior descending artery.A 3.75mm x 12mm quantum maverick balloon catheter was advanced for dilation.However, during inflation, the balloon ruptured.The procedure was completed with another of the same device.There were no patient complications nor injuries reported and the patient's status was stable.
Event or Problem Description
It was reported that balloon rupture occurred.The 88% stenosed, 28-32mmx4.0-4.5mm target lesion was located in the moderately tortuous and severely calcified left anterior descending artery.A 3.75mm x 12mm quantum maverick balloon catheter was advanced for dilation.However, during inflation, the balloon ruptured.The procedure was completed with another of the same device.There were no patient complications nor injuries reported and the patient's status was stable.It was further reported that the balloon ruptured during first inflation and the device was completely removed from the patient's body without any intervention performed.
Additional Manufacturer Narrative
E1 initial reporter facility name: (b)(6) hospital.
Event or Problem Description
It was reported that balloon rupture occurred.The 88% stenosed, 28-32mmx4.0-4.5mm target lesion was located in the moderately tortuous and severely calcified left anterior descending artery.A 3.75mm x 12mm quantum maverick balloon catheter was advanced for dilation.However, during inflation, the balloon ruptured.The procedure was completed with another of the same device.There were no patient complications nor injuries reported and the patient's status was stable.It was further reported that the balloon ruptured during first inflation and the device was completely removed from the patient's body without any intervention performed.
Additional Manufacturer Narrative
E1 initial reporter facility name: device evaluated by mfr.: returned product consisted of a quantum maverick balloon catheter.The shaft, hypotube, tip and balloon were microscopically and visually examined.There were numerous kinks.There was a complete separation on the strain relief and the hub was missing.There was a complete separation at 93.1cm distal of the strain relief.There was blood in the guidewire lumen.The balloon was tightly folded.Microscopic inspection revealed tip damage.Inspection of the remainder of the device presented no other damage or irregularities.

• Brand Name: QUANTUM MAVERICK
• Common Device Name: CATHETERS, TRANSLUMINAL CORONARY ANGIOPLASTY, PERCUTANEOUS
• Manufacturer (Section D): BOSTON SCIENTIFIC CORPORATION; two scimed place; maple grove MN 55311
• MDR Report Key: 9946744
• Report Number: 2134265-2020-04806
• Device Sequence Number: 766429
• Product Code: LOX
• UDI-Device Identifier: 08714729392705
• UDI-Public: 08714729392705
• Combination Product (Y/N): N
• Initial Reporter Country: CH
• PMA/510(K) Number: P860019
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: company representative,distri
• Initial Reporter Occupation: Physician
• Type of Report: Initial,Followup,Followup
• Report Date (Section B): 06/09/2020

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: 08/19/2022
• Device Model Number: 7010
• Device Catalogue Number: 7010
• Device Lot Number: 0024293790
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 04/23/2020
• Initial Date Received by Manufacturer: 03/30/2020
• Supplement Date Received by Manufacturer: 04/03/2020; 05/14/2020
• Initial Report FDA Received Date: 04/09/2020
• Supplement Report FDA Received Date: 04/21/2020; 06/09/2020
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1
• Patient Age: 65 YR
• Patient Weight: 70