MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a company representative,foreig report with the FDA on 2020-03-08 for AMPLATZER SEPTAL OCCLUDER 9-ASD-020 manufactured by Aga Medical Corporation.
[184071163]
The results/method and conclusion codes along with investigation results will be provided in the final report.
Patient Sequence No: 1, Text Type: N, H10
[184071164]
On (b)(6) 2020, a 20mm amplatzer septal occluder (asd) was selected for implant. When deploying the device, the left side disk formed a "cobra" shape. The device was removed and exchanged with a new 20mm asd, which was successfully implanted.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 2135147-2020-00109 |
| MDR Report Key | 9803934 |
| Report Source | COMPANY REPRESENTATIVE,FOREIG |
| Date Received | 2020-03-08 |
| Date of Report | 2020-04-01 |
| Date of Event | 2020-01-22 |
| Date Mfgr Received | 2020-03-17 |
| Device Manufacturer Date | 2017-03-04 |
| Date Added to Maude | 2020-03-08 |
| Event Key | 0 |
| Report Source Code | Manufacturer report |
| Manufacturer Link | Y |
| Number of Patients in Event | 0 |
| Adverse Event Flag | 3 |
| Product Problem Flag | 3 |
| Reprocessed and Reused Flag | 3 |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 3 |
| Event Location | 3 |
| Manufacturer Contact | PAMELA YIP |
| Manufacturer Street | 5050 NATHAN LANE N |
| Manufacturer City | PLYMOUTH MN 55442 |
| Manufacturer Country | US |
| Manufacturer Postal | 55442 |
| Manufacturer Phone | 6517565400 |
| Manufacturer G1 | AGA MEDICAL CORPORATION |
| Manufacturer Street | 5050 NATHAN LANE NORTH |
| Manufacturer City | PLYMOUTH MN 55442 |
| Manufacturer Country | US |
| Manufacturer Postal Code | 55442 |
| Single Use | 3 |
| Remedial Action | RL |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | AMPLATZER SEPTAL OCCLUDER |
| Generic Name | TRANSCATHETER SEPTAL OCCLUDER |
| Product Code | MLV |
| Date Received | 2020-03-08 |
| Returned To Mfg | 2020-03-04 |
| Model Number | 9-ASD-020 |
| Catalog Number | 9-ASD-020 |
| Lot Number | 5885990 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | R |
| Device Age | DA |
| Device Eval'ed by Mfgr | Y |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | AGA MEDICAL CORPORATION |
| Manufacturer Address | 5050 NATHAN LANE NORTH PLYMOUTH MN 55442 US 55442 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Required No Informationntervention | 2020-03-08 |