FDA Adverse Event Injury Summary report: N

SOLYX SIS SYSTEM

MDR report key: 3053000 · Received April 11, 2013

Report

Report Number
3005099803-2013-02144
Event Type
Injury
Date Received
April 11, 2013
Report Date
March 15, 2013
Manufacturer
BOSTON SCIENTIFIC - MARLBOROUGH
Product Code
FTL
PMA / PMN Number
K081275
Adverse Event
Yes
Report Source
Manufacturer report
Reporter Location
GA, US
Reporter Occupation
PHYSICIAN

Narratives

Description of Event or Problem · 1

IT WAS REPORTED TO BOSTON SCIENTIFIC CORPORATION THAT A SOLYX SIS SYSTEM WAS IMPLANTED (B)(6) 2009. A RIGHT LAPAROSCOPIC SALPINGO-OOPHORECTOMY WITH CYSTOSCOPY WAS ALSO PERFORMED. ACCORDING TO THE COMPLAINANT, THE PATIENT EXPERIENCED AN UNKNOWN INJURY. ACCORDING TO THE PHYSICIAN'S OFFICE, THE PATIENT'S FIRST FOLLOW-UP VISIT WAS (B)(6) 2009. THE PATIENT WAS ABLE TO VOID WELL, WITHOUT INCONTINENCE. THE PHYSICIAN PRESCRIBED TORADOL FOR POST-OPERATIVE DISCOMFORT. THE PATIENT PHONED THE PHYSICIAN (B)(6) 2009 DUE TO INCREASED PELVIC PAIN, BUT SHE REPORTEDLY CONTINUED TO VOID WELL, WITHOUT INCONTINENCE. THE PHYSICIAN PRESCRIBED PAIN MEDICATION (TYPE UNKNOWN). THE PATIENT'S SECOND POST-OPERATIVE VISIT WAS (B)(6) 2009. THE PATIENT REPORTED THAT SHE WAS STILL EXPERIENCING PELVIC PAIN AND REQUESTED TO HAVE HER LEFT OVARY REMOVED. THE PATIENT RETURNED FOR A THIRD POST-OPERATIVE VISIT (B)(6) 2009. THE PHYSICIAN PERFORMED A PELVIC ULTRASOUND WHICH REVEALED THREE CYSTS ON THE LEFT OVARY. THE PATIENT'S FINAL POST-OPERATIVE VISIT WAS (B)(6) 2010. THE PATIENT REPORTED CONTINUED PELVIC PAIN BUT SHE CONTINUED TO VOID WELL, WITH NO INCONTINENCE. SHE REPORTEDLY HAD SEEN A UROLOGIST, WHO OPINED THAT THE CAUSE OF THE PAIN WAS TIGHT PELVIC FLOOR MUSCULATURE. ALL OTHER INFORMATION IS UNKNOWN. SHOULD ADDITIONAL RELEVANT DETAILS BECOME AVAILABLE; A SUPPLEMENTAL REPORT WILL BE SUBMITTED.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
154968 SOLYX SIS SYSTEM MESH, SURGICAL, POLYMERIC FTL BOSTON SCIENTIFIC - MARLBOROUGH UNK660

Patients

Seq Age Sex Outcome Treatment
1 Required Intervention