BEUDAMED
    FDA Adverse Event Injury Summary report: N

    AVAULTA SOLO ANTERIOR SYNTHETIC SUPPORT SYSTEM

    MDR report key: 3150124 · Received May 31, 2013

    Report

    Report Number
    1018233-2013-02318
    Event Type
    Injury
    Date Received
    May 31, 2013
    Report Date
    April 18, 2018
    Manufacturer
    C.R. BARD, INC. (COVINGTON) -1018233
    Product Code
    OTP
    PMA / PMN Number
    K082571
    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 ADVERSE REACTIONS: "POTENTIAL ADVERSE REACTIONS ARE THOSE TYPICALLY ASSOCIATED WITH SURGICALLY IMPLANTABLE MATERIALS, INCLUDING HEMATOMA, SEROMA, MUCOSAL OR VISCERAL EROSION, INFECTION, INFLAMMATION, SENSITIZATION, DYSPAREUNIA, SCARIFICATION AND CONTRACTION, FISTULA FORMATION, EXTRUSION AND RECURRENCE OF VAGINAL WALL PROLAPSE. PERFORATIONS OR LACERATIONS OF VESSELS, NERVES, BLADDER, BOWEL, RECTUM, OR ANY VISCERA MAY OCCUR DURING NEEDLE PASSAGE." (B)(4).

    Description of Event or Problem · 1

    COMPLAINT NUMBER: (B)(4). IT WAS REPORTED BY THE PATIENT'S ATTORNEY THAT AS A RESULT OF HAVING THE PRODUCT IMPLANTED, THE PATIENT HAS EXPERIENCED PAIN, AND PHYSICAL IMPAIRMENT. ASSOCIATED MDR NUMBER: 1018233-2013-02317.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    240187 AVAULTA SOLO ANTERIOR SYNTHETIC SUPPORT SYSTEM NO MATCH OTP C.R. BARD, INC. (COVINGTON) -1018233 NA HUSH1458
    240218 AVAULTA SOLO ANTERIOR SYNTHETIC SUPPORT SYSTEM NO MATCH OTP C.R. BARD, INC. (COVINGTON) -1018233 NA HUSH1458

    Patients

    Seq Age Sex Outcome Treatment
    1 55 YR Female Required Intervention AVAULATA SOLO POSTERIOR SYNTHETIC SUPPORT SYSTEM| MONARC SUBFACIAL HAMMOCK| AVAULATA SOLO POSTERIOR SYNTHETIC SUPPORT SYSTEM