FDA Adverse Event Injury Summary report: N

AVAULTA ANTERIOR BIOSYNTHETIC SUPPORT SYSTEM

MDR report key: 3172335 · Received April 18, 2013

Report

Report Number
1018233-2013-01073
Event Type
Injury
Date Received
April 18, 2013
Report Date
March 29, 2013
Manufacturer
SOFRADIM PRODUCTIONS
Product Code
FTL
Adverse Event
Yes
Report Source
Distributor report
Reporter Location
MO, US
Reporter Occupation
ATTORNEY

Narratives

Description of Event or Problem · 1

IT WAS REPORTED IN THE PT'S MEDICAL RECORDS THAT AS A RESULT OF HAVING THE PRODUCT IMPLANTED, THE PT HAS EXPERIENCED BILATERAL PELVIC PAIN, NAUSEA, MINIMAL BLEEDING, LEFT-SIDED BUTTOCK PAIN, CYSTOCELE (CORRECTED AFTER AVAULTA, RECURRENT, AND GRADE 2), "DOES NOT HAVE THE CONTROL TO STOP AND START URINATION," URGENCY, URINARY INCONTINENCE (RECURRENT, RESOLVED AFTER TOT, MILD, OCCASIONAL, AND RESOLVED), "STRING HANGING OUT OF HER VAGINA," MILD STOMACH CRAMPS, ABDOMINAL CRAMPING, ABDOMINAL PAIN (GENERALIZED, OCCASIONAL, AND "RESIDES AFTER RESTING"), OCCASIONAL PINK DISCHARGE, URINARY INTERMITTENCY, NOCTURIA, GROSS HEMATURIA, SMALL AREA OF WOUND SEPARATION WITH 1CM OF EXPOSED MESH AT THE VAGINAL INCISION SITE, SHARP PAIN THAT STARTS AT THE VAGINA AND MOVES UP TOWARD THE BLADDER, "DOES NOT ALWAYS KNOW WHEN SHE NEEDS TO URINATE," EXCISION OF MESH AND REVISION OF VAGINAL WOUND, EROSION OF VAGINAL MESH, SURGICAL SPECIMEN FRAGMENTS OF REACTIVE STOMA AND SQUAMOUS EPITHELIUM WITH ACUTE AND CHRONIC INFLAMMATION, RECURRENT URINARY TRACT INFECTION, PAINFUL URINATION, PAIN AFTER VOIDING, FREQUENCY, INCOMPLETE EMPTYING, GRADE 2 RECTOCELE, MESH PALPABLE JUST BENEATH THE SURFACE BUT NO SIGNIFICANT EROSION, PAIN IN THE LOWER LEFT ABDOMINAL AREA, AND "FEELS MESH COMING OUT" AFTER SHE UNDERWENT CYSTOCELE REPAIR WITH INLAY OF MESH, VAGINAL VAULT SUSPENSION, TRANSOBTURATOR TAPE MIDURETHRAL SLING AND CYSTOSCOPY. IT WAS REPORTED BY THE PT'S ATTORNEY THAT AS A RESULT OF HAVING THE PRODUCT IMPLANTED, THE PT HAS EXPERIENCED SIGNIFICANT MENTAL AND PHYSICAL PAIN AND SUFFERING, HAS SUSTAINED PERMANENT INJURY, AND PERMANENT AND SUBSTANTIAL PHYSICAL DEFORMITY, AND WILL LIKELY UNDERGO CORRECTIVE SURGERY OR SURGERIES. ASSOCIATED MDR: 1018233-2013-01074.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
168673 AVAULTA ANTERIOR BIOSYNTHETIC SUPPORT SYSTEM FTL SOFRADIM PRODUCTIONS NA ZGJ00591

Patients

Seq Age Sex Outcome Treatment
1 55 YR Required Intervention LONG STAR| PELVILACE BIOURETHRAL SUPPORT SYSTEM