FDA Adverse Event Injury Summary report: N

PELVICOL 2CM X 7CM 1.0MM

MDR report key: 2840398 · Received August 21, 2012

Report

Report Number
9617613-2012-00137
Event Type
Injury
Date Received
August 21, 2012
Report Date
February 28, 2018
Manufacturer
COVIDIENT, FORMERLY TISSUE¿
Product Code
FTL
PMA / PMN Number
K992556
Adverse Event
Yes
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
GA, US
Reporter Occupation
OTHER

Narratives

Additional Manufacturer Narrative · 1

(B)(4).

Additional Manufacturer Narrative · 1

IF INFORMATION IS PROVIDED IN THE FUTURE, A SUPPLEMENTAL REPORT WILL BE ISSUED.

Description of Event or Problem · 1

PROCEDURE: UROLOGICAL/GYNECOLOGICAL. ACCORDING TO THE REPORTER: THE PT UNDERWENT A REPAIR PROCEDURE AND THE PT ALLEGEDLY EXPERIENCED PAIN AND INJURY. PT HAS UNDERGONE OR WILL UNDERGO CORRECTIVE SURGERY OR SURGERIES.

Description of Event or Problem · 1

PER ADDITIONAL INFORMATION RECEIVED, COMPLICATIONS POST IMPLANT INCLUDE:ABDOMINAL PAIN, URINARY INCONTINENCE, CONSTIPATION, VAGINAL DISCHARGE, URINARY URGENCY, URGE INCONTINENCE, VAGINAL AND RECTAL PAIN, CONSTIPATION, URINARY TRACT INFECTIONS. (B)(6) 2007: UNDERWENT EXAMINATION UNDER ANESTHESIA WITH EXCISION OF SUTURE MATERIAL AND CYSTOSCOPY FOR ABDOMINAL AND SUPRAPUBIC PAIN STATUS POST SLING. MIXED STRESS/ URGE INCONTINENCE UNDER GENERAL LARYNGEAL MASK AIRWAY ANESTHESIA. CONDITIONS POST INTERVENTIONS SURGERY: DYSURIA, FREQUENCY, DYSPAREUNIA, INCONTINENCE, AND URGENCY, LOWER ABDOMINAL AND PELVIC PAIN, BURNING WITH URINATION. (B)(6) 2012: UNDERWENT CYSTOSCOPY AND BOTOX INJECTION, 200 UNITS OF BOTOX FOR REFRACTORY URGE INCONTINENCE. (B)(6) 2014: UNDERWENT CYSTOSCOPY WITH BOTOX INJECTION FOR URINARY INCONTINENCE .UNDER GENERAL ANESTHESIA. CONDITIONS POST THIRD INTERVENTION SURGERY: URGE URINARY INCONTINENCE, URINARY RETENTION, AND URINARY TRACT INFECTION, SUPRAPUBIC PAIN AND BLADDER SPASMS.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1 PELVICOL 2CM X 7CM 1.0MM PELVICOL MESH FTL COVIDIENT, FORMERLY TISSUE¿ 08B19-T

Patients

Seq Age Sex Outcome Treatment
1 Other| R