BEUDAMED
    FDA Adverse Event Injury Summary report: N

    UKNOWN MESH PRODUCT

    MDR report key: 3161882 · Received June 11, 2013

    Report

    Report Number
    2210968-2013-10053
    Event Type
    Injury
    Date Received
    June 11, 2013
    Report Date
    November 11, 2016
    Manufacturer
    ETHICON INC.
    Product Code
    OTN
    Removal / Correction Number
    NA
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    PA, US
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 1

    (B)(4). SHOULD ADDITIONAL INFORMATION BE OBTAINED, A SUPPLEMENTAL 3500A FORM WILL BE SUBMITTED ACCORDINGLY.

    Additional Manufacturer Narrative · 1

    (B)(4). IT WAS REPORTED THAT THE PATIENT UNDERWENT A GYNECOLOGICAL PROCEDURE AND MESH WAS IMPLANTED CONCURRENTLY WITH I&D OF MULTIPLE INCLUSION CYSTS OF THE VULVA; DUE TO CYSTOCELE, RECTOCELE AND STRESS URINARY INCONTINENCE.

    Additional Manufacturer Narrative · 1

    (B)(4). ADDITIONAL NARRATIVE: IT WAS REPORTED BY AN ATTORNEY THAT THE PATIENT UNDERWENT A GYNECOLOGICAL PROCEDURE ON (B)(6) 2008 AND A MESH WAS IMPLANTED. IT WAS REPORTED THAT PATIENT UNDERWENT REVISION OF PUBOVAGINAL SLING (VAGINAL APPROACH) AND URETHROLYSIS ON (B)(6) 2012 DUE TO VOIDING DYSFUNCTIONS AND PERIURETHRAL FIBROSIS. IT WAS REPORTED THAT PATIENT UNDERWENT URETHRAL MESH EXCISION AND URETHROLYSIS ON (B)(6) 2013 DUE TO PELVIC PAIN, AND HISTORY OF URETHRAL SLING. NO ADDITIONAL INFORMATION WAS PROVIDED.

    Description of Event or Problem · 1

    IT WAS REPORTED THAT THE PATIENT UNDERWENT A GYNECOLOGICAL PROCEDURE ON (B)(6) 2008 AND MESH WERE IMPLANTED. THE PATIENT EXPERIENCED PAIN, EROSION OF HER INTERNAL BODILY TISSUE AND OTHER INJURIES FOLLOWING THE PROCEDURE. IT WAS REPORTED THAT THE PATIENT HAS UNDERGONE MULTIPLE SURGERIES AND REVISIONARY PROCEDURES. NO ADDITIONAL INFORMATION WAS PROVIDED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    262306 UKNOWN MESH PRODUCT MESH, SURGICAL, SYNTHETIC, UROGYNECOLOGICAL OTN ETHICON INC. UNK

    Patients

    Seq Age Sex Outcome Treatment
    1 51 YR Required Intervention