FDA Adverse Event Injury Summary report: N

SOLYX SIS SYSTEM

MDR report key: 3191334 · Received June 26, 2013

Report

Report Number
3005099803-2013-05192
Event Type
Injury
Date Received
June 26, 2013
Report Date
June 5, 2013
Manufacturer
BOSTON SCIENTIFIC - MARLBOROUGH
Product Code
FTL
PMA / PMN Number
K081275
Adverse Event
Yes
Report Source
Manufacturer report
Reporter Location
AL, US
Reporter Occupation
PHYSICIAN

Narratives

Description of Event or Problem · 1

IT WAS REPORTED TO BOSTON SCIENTIFIC CORPORATION THAT A SOLYX SINGLE INCISION SLING SYSTEM WAS IMPLANTED ON (B)(6) 2011. ACCORDING TO THE COMPLAINANT, POST-PROCEDURE, THE PATIENT PRESENTED WITH UNSPECIFIED COMPLICATIONS. ADDITIONAL INFORMATION RECEIVED FROM THE PHYSICIAN'S OFFICE ON (B)(6) 2013 NOTED THAT THE PATIENT FOLLOWED UP ON (B)(6) 2011 COMPLAINING OF FEVER AND PAIN. ON (B)(6) 2011, THE PATIENT COMPLAINED TO THE PHYSICIAN OF HAVING RECTAL PRESSURE; ESPECIALLY WHEN LYING DOWN. ON (B)(6) 2011, SHE INFORMED THE DOCTOR THAT SHE EXPERIENCED LEFT PELVIC PAIN WHEN MOVING CERTAIN WAYS; THE LEFT ARM OF THE SOLYX DEVICE WAS BULGING. ON (B)(6) 2011, THE PATIENT FOLLOWED UP WITH THE DOCTOR NOTING PAIN WHILE SITTING AND BENDING, ALONG WITH RECTAL PRESSURE. THE RIGHT AND LEFT ARMS OF THE SOLYX DEVICE WERE BULGING CREATING PAIN. THE PHYSICIAN REFERRED THE PATIENT TO A UROGYNECOLOGIST. THE PATIENT WAS LAST SEEN IN (B)(6) 2011 WITH SEVERE PAIN. SHE WAS GIVEN PAIN MEDICATION WHICH SHE WAS TAKING EVERY 2 HOURS. 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
289837 SOLYX SIS SYSTEM MESH, SURGICAL, POLYMERIC FTL BOSTON SCIENTIFIC - MARLBOROUGH UNK660

Patients

Seq Age Sex Outcome Treatment
1 Required Intervention