FDA Adverse Event Injury Summary report: N

ESSURE DEVICE

MDR report key: 3010739 · Received March 13, 2013

Report

Report Number
MW5029387
Event Type
Injury
Date Received
March 13, 2013
Date of Event
February 18, 2013
Report Date
March 13, 2013
Manufacturer
CONCEPTUS INC
Product Code
HHS
Product Problem
Yes
Report Source
Voluntary report
Reporter Location
MI, US
Reporter Occupation
RISK MANAGER

Narratives

Description of Event or Problem · 1

ESSURE DEVICE DID NOT DEPLOY COMPLETELY, STUCK IN FALLOPIAN TUBE WITH PLASTIC SHEATH CAUSING BLEEDING. DEVICE BAGGED FOR FURTHER INVESTIGATION. SURGEON STATES DISCLOSURE TO PT FAMILY, DOES NOT FEEL THERE WILL BE A NEED FOR FURTHER PROCEDURE. REP CONTACTED DURING PROCEDURE FOR SUPPORT/IDEAS. DR (B)(6) ALSO CAME TO ROOM FOR CONSULTATION AS HE USES THIS SYSTEM. SURGEON FELT THERE WAS NOTHING THAT COULD HAVE BEEN DONE PRIOR TO OR DURING FOR PREVENTION OF INCIDENT. UPON WHEELING BACK, THE ESSURE DEVICE, FOLLOWING DEPLOYMENT, THE TRAILING END OF THE WIRE REMAINED ATTACHED TO THE COILS AND THIS RESULTED IN AN EXCESSIVE AMOUNT OF WIRE LEFT WITHIN THE UTERINE CAVITY. THE WIRE INCLUDED THE GREEN PLASTIC COVERING. IN ORDER TO REMOVE THIS TRAILING WIRE FROM THE UTERINE CAVITY, THE OPERATIVE HYSTEROSCOPE NEEDED TO BE EXCHANGED FOR AN OPERATIVE CYSTOSCOPE, WHICH COULD ACCOMMODATE A LARGER SCISSOR. ONCE THE CYSTOSCOPE WAS SET UP, WAS PLACED WITHIN THE PT'S UTERINE CAVITY, THE CYSTOSCOPIC SCISSORS WERE USED TO TRIM THE WIRE SO THAT THE TRAILING END OF THAT WIRE OFF THE COILS WAS NEARLY FLUSH WITH THE TUBAL OSTIA, APPROX 2 COILS OF THAT WIRE REMAINED TRAILING FROM THE OSTIA SITE. THIS CONCLUDED THE PROCEDURE. EVENT ABATED AFTER USE STOPPED: YES. DIAGNOSIS OR REASON FOR USE: HYSTEROSCOPY WITH ESSURE.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
106701 ESSURE DEVICE ESSURE HHS CONCEPTUS INC ESS305 A36521

Patients

Seq Age Sex Outcome Treatment
1 33 YR Required Intervention