MAUDE Adverse Event Report: ABBOTT MEDICAL AMPLATZER SEPTAL OCCLUDER; TRANSCATHETER SEPTAL OCCLUDER

Catalog Number	9-ASD-036
Medical Device Problem Code	Difficult to Fold, Unfold or Collapse (1254)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	04/29/2024
Type of Reportable Event	Malfunction
Event or Problem Description
It was reported that on (b)(6) 2024, a 36mm amplatzer septal occluder was selected for implant.During the implant procedure, while the device was being deployed, the first disc was placed in the defect.However, it had to be recaptured twice because the device didn't fit properly with respect to the aortic dorsum.When the occluder was deployed on the third attempt, it presented in a cobra deformation.The device was removed from the patient.There was no interaction with cardiac structures or kink/angulation noticed in the delivery system.The patient remained hemodynamically stable throughout the procedure.There was no adverse health consequences to the patient and is stable.
Additional Manufacturer Narrative
The device is expected to be returned for evaluation.It has not yet been received.A follow-up report will be submitted with all additional relevant information.
Event or Problem Description
It was reported that on (b)(6) 2024, a 36mm amplatzer septal occluder was selected for implant.During the implant procedure, while the device was being deployed, the first disc was placed in the defect.However, it had to be recaptured twice because the device didn't fit properly with respect to the aortic dorsum.When the occluder was deployed on the third attempt, it presented in a cobra deformation.The device was removed from the patient.There was no interaction with cardiac structures or kink/angulation noticed in the delivery system.The patient remained hemodynamically stable throughout the procedure.There was no adverse health consequences to the patient and is stable.
Additional Manufacturer Narrative
An event of device deformity during deployment was reported.The investigation confirmed the device met functional and dimensional specifications when analyzed at abbott.Information from field indicated that there was no interaction with cardiac structures or kink/angulation noticed in the delivery system.The device history record was reviewed to ensure that each manufacturing and inspection operation was performed and the product met all specifications.The cause of the reported incident could not be conclusively determined.There is no indication of a product quality issue with respect to labeling design or manufacturing of the device.

• Brand Name: AMPLATZER SEPTAL OCCLUDER
• Common Device Name: TRANSCATHETER SEPTAL OCCLUDER
• Manufacturer (Section D): ABBOTT MEDICAL; 5050 nathan lane n; plymouth MN 55442
• Manufacturer (Section G): ST. JUDE MEDICAL #3014918977; edificio #44 calle 0, ave. 2; el coyol alajuela 1897- 4050; CS 1897-4050
• Manufacturer Contact: karen krouse ; 5050 nathan lane n; plymouth, MN 55442 ; 6517565400
• MDR Report Key: 19607435
• Report Number: 2135147-2024-02996
• Device Sequence Number: 8485715
• Product Code: MLV
• UDI-Device Identifier: 00811806010250
• UDI-Public: (01)00811806010250(17)271231(10)8843315
• Combination Product (Y/N): N
• Initial Reporter Country: MX
• PMA/510(K) Number: P000039
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2024
• Device Explanted Year: 2024
• 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
• Report Date (Section B): 09/23/2024

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 Catalogue Number: 9-ASD-036
• Device Lot Number: 8843315
• 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: 05/31/2024
• Supplement Date Received by Manufacturer: 09/09/2024
• Initial Report FDA Received Date: 06/25/2024
• Supplement Report FDA Received Date: 09/23/2024
• Was Device Evaluated by Manufacturer? (Y/N): Yes
• Date Device Manufactured: 01/16/2023
• 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
• Patient Sex: Male