BEUDAMED
    FDA Adverse Event Injury Summary report: N

    AVAULTA SOLO SYNTHETIC SUPPORT SYSTEM- ANTERIOR

    MDR report key: 3213805 · Received July 3, 2013

    Report

    Report Number
    1018233-2013-02713
    Event Type
    Injury
    Date Received
    July 3, 2013
    Report Date
    October 31, 2016
    Manufacturer
    C.R. BARD, INC.
    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

    (B)(4). THE PATIENT'S ATTORNEY ALLEGED A DEFICIENCY AGAINST THE DEVICE. ADD'L INFO HAS BEEN REQUESTED, BUT NOT RECEIVED. ASSOCIATED MDRS: 1018233-2013-02712, 1018233-2013-02714, AND 1018233-2013-02715.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    303785 AVAULTA SOLO SYNTHETIC SUPPORT SYSTEM- ANTERIOR No Match OTP C.R. BARD, INC. NA CVSC0011
    303867 AVAULTA SOLO SYNTHETIC SUPPORT SYSTEM- ANTERIOR No Match OTP C.R. BARD, INC. NA CVSC0011

    Patients

    Seq Age Sex Outcome Treatment
    1 77 YR Female Required Intervention ALIGN TO URETHRAL SUPPORT SYSTEM| ALIGN URETHRAL SUPPORT SYSTEM | ANTERIOR, PROD # 486100| AVAULTA SOLO SYNTHETIC SUPPORT SYSTEM| PROD # BRD500HL, LOT # CVSA0022| AVAULTA SOLO SYNTHETIC SUPPORT SYSTEM| ALIGN TO URETHRAL SUPPORT SYSTEM| ALIGN URETHRAL SUPPORT SYSTEM,| ANTERIOR, PROD # 486100| PROD # BRD500HL, LOT # CVSA0022