MAUDE Adverse Event Report: ABBOTT MEDICAL AMPLATZER VASCULAR PLUG II; DEVICE, VASCULAR, FOR PROMOTING EMBOLIZATION

Model Number	9-AVP2-010
Medical Device Problem Codes	Migration or Expulsion of Device (1395); Patient Device Interaction Problem (4001)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	07/01/2022
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
Investigation is not yet complete.A follow-up report will be submitted with all additional relevant information.
Event or Problem Description
It was reported that on (b)(6) 2022 a 10mm amplatzer vascular plug ii was successfully implanted using a 5f non-abbott delivery sheath.Three minutes after the device was deployed the device embolized into the arterial duct, discovered via angiography.Contrast was injected and it was noted that the contrast was still able to pass through the target vessel.The device was removed via transcatheter snare and replaced with a non-abbott device.It was noted that the diameter selection of the device was suitable, but the length was too long, which leads to poor adhesion.The patient remained hemodynamically stable throughout the procedure.The patient is stable and discharged.
Event or Problem Description
It was reported that on (b)(6) 2022 a 10mm amplatzer vascular plug ii was successfully implanted using a 5f non-abbott delivery sheath.Three minutes after the device was deployed the device embolized into the arterial duct, discovered via angiography.Contrast was injected and it was noted that the contrast was still able to pass through the target vessel.The device was removed via transcatheter snare and replaced with a non-abbott device.It was noted that the diameter selection of the device was suitable, but the length was too long, which leads to poor adhesion.The patient remained hemodynamically stable throughout the procedure.The patient is stable and discharged.Subsequent to the previously filed report, additional information was received that the date of procedure was (b)(6) 2022.
Additional Manufacturer Narrative
An event of device embolization was reported.Based on the information received, the cause of the reported incident could not be conclusively determined.The device history record was reviewed to ensure that each manufacturing and inspection operation was performed and the product met all specifications.There were no complaints associated with any other devices from the lot.There is no indication of a product quality issue with respect to labeling design or manufacturing of the device.D6a - implant date: updated to (b)(6) 2022.
Additional Manufacturer Narrative
An event of residual shunt was reported.The investigation confirmed the device met functional and dimensional specifications when analyzed at abbott.The device history record was reviewed to ensure that each manufacturing and inspection operation was performed and that the product met all specifications.There were no complaints associated with any other devices from the lot.Information from the field indicated the diameter selection of the device was suitable, but the length was too long, which leads to poor adhesion.There is no indication of a product quality issue with respect to labeling design or manufacturing of the device.B3 - date of event - corrected h6.Medical device problem code 1395 migration or expulsion of device removed 4001 patient device interaction problem.
Event or Problem Description
Subsequent to the previously filed report, additional information was received that the date of procedure was (b)(6) 2022, not (b)(6) 2022.

• Brand Name: AMPLATZER VASCULAR PLUG II
• Common Device Name: DEVICE, VASCULAR, FOR PROMOTING EMBOLIZATION
• Manufacturer (Section D): ABBOTT MEDICAL; 5050 nathan lane n; plymouth MN 55442
• Manufacturer (Section G): ABBOTT MEDICAL REG# 2135147; 5050 nathan ln n; plymouth MN 55442
• Manufacturer Contact: karen krouse ; 5050 nathan lane n; plymouth, MN 55442 ; 6517565400
• MDR Report Key: 15116087
• Report Number: 2135147-2022-00581
• Device Sequence Number: 14850327
• Product Code: KRD
• UDI-Device Identifier: 00811806010380
• UDI-Public: 00811806010380
• Combination Product (Y/N): N
• Initial Reporter Country: CH
• PMA/510(K) Number: K071699
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2022
• Device Explanted Year: 2022
• Serviced by Third Party (Y/N): N
• Reporter Type: Manufacturer
• Report Source: Foreign,Health Professional,Company Representative
• Initial Reporter Occupation: Physician
• Type of Report: Initial,Followup,Followup
• Report Date (Section B): 01/09/2023

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: Yes
• Operator of Device: Health Professional
• Device Expiration Date: 09/30/2023
• Device Model Number: 9-AVP2-010
• Device Catalogue Number: 9-AVP2-010
• Device Lot Number: 6705631
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Is the Reporter a Health Professional?: Yes
• Type of Report(Section G): Initial
• Initial Date Received by Manufacturer: 07/05/2022
• Supplement Date Received by Manufacturer: 11/10/2022; 12/21/2022
• Initial Report FDA Received Date: 07/27/2022
• Supplement Report FDA Received Date: 11/25/2022; 01/09/2023
• Was Device Evaluated by Manufacturer? (Y/N): Yes
• Date Device Manufactured: 10/23/2018
• Is the Device Labeled for Single Use? (Y/N): Yes
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Usage of Device: Initial
• Patient Sequence Number: 1
• Concomitant Medical Products and Therapy/Usage Dates: 5F SHEATH.
• Outcome Attributed to Adverse Event: Required Intervention
• Patient Sex: Unknown