MAUDE Adverse Event Report: ABBOTT MEDICAL MITRACLIP G5 DELIVERY SYSTEM; MITRAL VALVE REPAIR DEVICES

Model Number	CDS0801-NT
Medical Device Problem Code	Unintended Movement (3026)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	05/07/2026
Type of Reportable Event	Malfunction
Event or Problem Description
It was reported that on (b)(6) 2026, a patient presented with grade 4 functional mitral regurgitation (mr) for a mitraclip procedure.During the procedure, first and second mitraclip ntw were implanted on the medial and central side of anterior and posterior leaflet (a2p2).Mitraclip nt was inserted into the patient and was placed on lateral side of anterior and posterior leaflet 3 (a3p3).Mitraclip nt was entangled with the medial mitraclip ntw.Mitraclip nt was freed and was inverted and brought to the left atrium.Orientation was checked and went sub valvular.A3p3 leaflets were grasped and leaflet inserted was checked and the mitraclip nt was implanted.Upon, release of the clip, clip opened.All steps were performed as per ifu.The final mr was grade 3.There were no adverse patient effects or clinically significant delays reported.
Event or Problem Description
It was reported that on (b)(6) 2026, a patient presented with grade 4 functional mitral regurgitation (mr) for a mitraclip procedure.During the procedure, first and second mitraclip ntw were implanted on the medial and central side of anterior and posterior leaflet (a2p2).Mitraclip nt was inserted into the patient and was placed on lateral side of anterior and posterior leaflet 3 (a3p3).Mitraclip nt was entangled with the medial mitraclip ntw.Mitraclip nt was freed and was inverted and brought to the left atrium.Orientation was checked and went sub valvular.A3p3 leaflets were grasped and leaflet inserted was checked and the mitraclip nt was implanted.Upon, release of the clip, clip opened.All steps were performed as per ifu.The final mr was grade 3.There were no adverse patient effects or clinically significant delays reported.
Additional Manufacturer Narrative
The device remains implanted in patient.The device will not be returned for evaluation.Investigation is not yet complete.A follow-up report will be submitted with all additional relevant information.
Additional Manufacturer Narrative
The device was not returned for analysis.A review of the lot history record revealed no manufacturing nonconformities issued to the reported lot that would have contributed to this event.Additionally, a review of the complaint history identified no similar complaints reported from this lot.All information was investigated and based on the images/cine review and the information provided by the account, the cause for the reported clip opened while locked cannot be determined.There is no indication of a product issue with respect to manufacture, design, or labeling.

• Brand Name: MITRACLIP G5 DELIVERY SYSTEM
• Common Device Name: MITRAL VALVE REPAIR DEVICES
• Manufacturer (Section D): ABBOTT MEDICAL; 5050 nathan lane n; plymouth MN 55442
• Manufacturer (Section G): ABBOTT MEDICAL NORTHPOINT REG 3020950818; 1820 bastian court; westfield IN 46074
• Manufacturer Contact: karen krouse ; 5050 nathan lane n; plymouth, MN 55442 ; 6517565400
• MDR Report Key: 25350848
• Report Number: 2135147-2026-03701
• Device Sequence Number: 21520369
• Product Code: NKM
• UDI-Device Identifier: 05415067050717
• UDI-Public: (01)05415067050717(17)270719(10)60116A1109
• Combination Product (Y/N): N
• Initial Reporter State: NY
• Initial Reporter Country: US
• PMA/510(K) Number: P100009
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2026
• Serviced by Third Party (Y/N): N
• Reporter Type: Manufacturer
• Report Source: Health Professional,Company Representative
• Initial Reporter Occupation: Physician
• Type of Report: Initial
• Report Date (Section B): 06/01/2026

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 Model Number: CDS0801-NT
• Device Catalogue Number: CDS0801-NT
• Device Lot Number: 60116A1109
• 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: 05/07/2026
• Initial Report FDA Received Date: 06/01/2026
• Was Device Evaluated by Manufacturer? (Y/N): No
• Date Device Manufactured: 01/19/2026
• 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: 2XMITRACLIP; STEERABLE GUIDE CATHETER
• Patient Age: 71 YR
• Patient Sex: Male
• Patient Weight: 188 LB