MAUDE Adverse Event Report: AGA MEDICAL CORPORATION AMPLATZER DUCT OCCLUDER; OCCLUDER, PATENT DUCTUS, ARTERIOSUS

Model Number 9-PDA-003

Device Problems Difficult to Insert (1316); Failure to Advance (2524)

Patient Problem No Consequences Or Impact To Patient (2199)

Event Date 12/12/2019

Event Type  malfunction  

Manufacturer Narrative

The results/method and conclusion codes along with investigation results will be provided in a subsequent submission.

Event Description

On (b)(6) 2019, a 5/4 mm pda occluder was selected for implant using a torqvue delivery system 5fr 90/080.During the procedure, the occluder failed to advance into the delivery sheath.The physician attempted to retract the device, but it remained stuck in the loading system.A new 5/4mm pda occluder and torqvue 5fr 90/080 were selected.Upon advancement, the occluder was stuck in the sheath again, but this time it was successfully retrieved into the loading system.A third delivery system torqvue 6fr was selected and successfully used to implant the second pda occluder.The patient is reported to be stable.Manufacturer report number: 2135147-2020-00019, 2135147-2020-00020, 2135147-2020-00005.

Manufacturer Narrative

Additional information: h3, h10; correction: h6.An event of inability to advance the occluder into the sheath was reported.The results of the investigation are inconclusive since the device remains implanted was not returned for analysis.The device history record was reviewed to ensure that each manufacturing and inspection operation was performed and the product met all specifications.Based on the information received, the cause of the reported incident could not be conclusively determined.

Manufacturer Narrative

Correction information for d2.Additional information for g4, g7, h2, h10.

• Brand Name: AMPLATZER DUCT OCCLUDER
• Type of Device: OCCLUDER, PATENT DUCTUS, ARTERIOSUS
• Manufacturer (Section D): AGA MEDICAL CORPORATION; 5050 nathan lane north; plymouth MN 55442
• MDR Report Key: 9606814
• MDR Text Key: 183166451
• Report Number: 2182269-2020-00001
• Device Sequence Number: 1
• Product Code: MAE
• UDI-Device Identifier: 00811806011103
• UDI-Public: 00811806011103
• Combination Product (y/n): N
• PMA/PMN Number: P020024
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: company representative,foreig
• Type of Report: Initial,Followup,Followup
• Report Date: 12/20/2020

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 01/20/2020
• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Device Operator: Health Professional
• Device Expiration Date: 01/31/2024
• Device Model Number: 9-PDA-003
• Device Catalogue Number: 9-PDA-003
• Device Lot Number: 6869767
• Was Device Available for Evaluation?: No
• Was the Report Sent to FDA?: No
• Date Manufacturer Received: 11/10/2020
• Is This a Reprocessed and Reused Single-Use Device?: No
• Patient Sequence Number: 1
• Treatment: 9-ITV05F180/60, 6864981; 9-PDA-003, 6869766; 9-TVLP5F90/080, 6398620