MAUDE Adverse Event Report: KA MEDICAL SIEGE; DEVICE, VASCULAR, FOR PROMOTING EMBOLIZATION

Catalog Number	SVP2.5-0.021
Medical Device Problem Code	Activation, Positioning or Separation Problem (2906)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	07/30/2025
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
This event was identified during internal quality system activities.Upon review, the manufacturer determined the event meets fda criteria for reporting.The report is being submitted to ensure accuracy and completeness of mdr files.This submission does not reflect a change in device performance or patient risk.The awareness date corresponds to when the manufacturer became aware of the event details.All information reasonably known to the manufacturer at this time has been included.The suspect device was not returned for evaluation.The complaint could not be confirmed.The root cause could not be determined.This complaint will be used to trend for similar complaints.A search of the complaint database was performed and no similar complaints for this lot number were found.The device history record was reviewed, and no exception documents were found.
Event or Problem Description
The customer reports the plug didn't deploy properly.No additional details were provided.
Additional Manufacturer Narrative
During secondary review it was determined this event was inadvertently reported under manufacturer number 3012276280 and it should have been reported under manufacturer number 1721504.We are cancelling this report and have sent in the event under the correct manufacturer number as seen in the report with g8 number 1721504-2026-00068.

• Brand Name: SIEGE
• Common Device Name: DEVICE, VASCULAR, FOR PROMOTING EMBOLIZATION
• Manufacturer (Section D): KA MEDICAL; 1265 grey fox road; suite 550; arden hills MN 55112
• Manufacturer Contact: 1265 grey fox road; suite 550; arden hills, MN 55112 ; 6512622810
• MDR Report Key: 24901270
• Report Number: 3012276280-2026-00013
• Device Sequence Number: 8938401
• Product Code: KRD
• UDI-Device Identifier: 00884450815908
• UDI-Public: 00884450815908
• Combination Product (Y/N): N
• Initial Reporter State: MN
• Initial Reporter Country: US
• PMA/510(K) Number: K240261
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): Unknown
• Reporter Type: Manufacturer
• Report Source: Health Professional,User Facility
• Initial Reporter Occupation: Other Health Care Professional
• Type of Report: Initial,Followup
• Report Date (Section B): 05/26/2026

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: SVP2.5-0.021
• Device Lot Number: 204656
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 07/30/2025
• Supplement Date Received by Manufacturer: Not provided
• Initial Report FDA Received Date: 04/16/2026
• Supplement Report FDA Received Date: 05/26/2026
• Was Device Evaluated by Manufacturer? (Y/N): No
• Date Device Manufactured: 12/27/2024
• 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: Unknown