BEUDAMED
    FDA Adverse Event Injury Summary report: N

    PELVILACE BIOURETHRAL SUPPORT SYSTEM

    MDR report key: 3062831 · Received April 12, 2013

    Report

    Report Number
    1018233-2013-01298
    Event Type
    Injury
    Date Received
    April 12, 2013
    Report Date
    January 3, 2018
    Manufacturer
    C.R. BARD, INC. (COVINGTON) -1018233
    Product Code
    PAG
    PMA / PMN Number
    K042949
    Removal / Correction Number
    NA
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    TX, US
    Reporter Occupation
    ATTORNEY
    Health Professional
    N

    Narratives

    Additional Manufacturer Narrative · 1

    THE SAMPLE WAS NOT RETURNED. THE FINISHED PRODUCT MET ALL SPECIFICATIONS PRIOR TO BEING RELEASED FOR GENERAL DISTRIBUTION. THE INSTRUCTIONS FOR USE WHICH ACCOMPANIES ALL DEVICES CURRENTLY ADDRESSES POTENTIAL RISKS ASSOCIATED WITH SURGICALLY IMPLANTED MATERIALS. THE INSTRUCTIONS FOR USE STATES IN THE PRECAUTIONS: "THE PELVILACE BIOURETHRAL SUPPORT SYSTEM IS FOR SINGLE-PT USE ONLY AND IS TO BE IMPLANTED SURGICALLY. DO NOT USE THE PELVILACE BIOURETHRAL SUPPORT SYSTEM IF THE INTEGRITY OF THE PACKAGING APPEARS COMPROMISED. THE PELVILACE BIOURETHRAL SUPPORT SYSTEM PELVICOL IMPLANT SHOULD BE HYDRATED OR MOIST WHEN THE PACKAGE IS OPENED. DEHYDRATED OR DRY TISSUE SHOULD NOT BE IMPLANTED. POSTOPERATIVE RETROPUBIC BLEEDING MAY OCCUR IN SOME PTS AND MUST BE CONTROLLED PRIOR TO PT RELEASE. THE PELVILACE BIOURETHRAL SUPPORT SYSTEM PROCEDURE REQUIRES DILIGENT ATTENTION TO ANATOMICAL STRUCTURE AND CARE TO AVOID PUNCTURE OF LARGE VESSELS, NERVES, BLADDER, AND BOWEL DURING NEEDLE PASSAGE. PROPER PLACEMENT OF THE PELVILACE BIOURETHRAL SUPPORT SYSTEM AT MID-URETHRA REQUIRES THAT THE TISSUE LIE FLAT WITH MINIMAL OR NO TENSION UNDER THE URETHRA. THE PELVILACE BIOURETHRAL SUPPORT SYSTEM IS INTENDED AS A SINGLE-USE, DISPOSABLE DEVICE. DO NOT RESTERILIZE ANY PORTION OF THE PELVILACE BIOURETHRAL SUPPORT SYSTEM. PTS SHOULD BE ADVISED THAT PREGNANCY FOLLOWING A PELVILACE BIOURETHRAL SUPPORT SYSTEM PROCEDURE MAY NEGATIVELY AFFECT THE SUCCESS OF THE PREVIOUS PROCEDURE AND INCONTINENCE MAY REOCCUR. THE SAFETY AND EFFECTIVENESS OF PELVILACE BIOURETHRAL SUPPORT SYSTEM HAS NOT BEEN ESTABLISHED FOR THE TREATMENT OF STRESS URINARY INCONTINENCE IN MALES AND CHILDREN UNDER THE AGE OF 18." (B)(4).

    Description of Event or Problem · 1

    THE PT'S ATTORNEY ALLEGED A DEFICIENCY AGAINST THE DEVICE. ADDITIONAL INFORMATION HAS BEEN REQUESTED, BUT NOT YET RECEIVED. PER ADDITIONAL INFORMATION RECEIVED, THE PT HAD EXPERIENCED EXPLORATORY LAPAROTOMY WITH LYSIS OF ADHESIONS INCLUDING EXTENSIVE ENTEROLYSIS AND BILATERAL SALPINGO-OOPHORECTOMY, PUBOVAGINAL SLING, AND CYSTOSCOPY.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    157408 PELVILACE BIOURETHRAL SUPPORT SYSTEM NO MATCH PAG C.R. BARD, INC. (COVINGTON) -1018233 NA BMVC0002
    157510 PELVILACE BIOURETHRAL SUPPORT SYSTEM NO MATCH PAG C.R. BARD, INC. (COVINGTON) -1018233 NA BMVC0002

    Patients

    Seq Age Sex Outcome Treatment
    1 37 YR Female Required Intervention FLOSEAL HEMOSTATIC MATRIX 5ML| FLOSEAL HEMOSTATIC MATRIX 5ML