BEUDAMED
    FDA Adverse Event Injury Summary report: N

    AVAULTA SOLO® SYNTHETIC SUPPORT SYSTEM - ANTERIOR

    MDR report key: 3233963 · Received July 16, 2013

    Report

    Report Number
    1018233-2013-02855
    Event Type
    Injury
    Date Received
    July 16, 2013
    Date of Event
    June 18, 2013
    Report Date
    November 3, 2017
    Manufacturer
    C.R. BARD, INC. (COVINGTON) -1018233
    Product Code
    OTP
    UDI-DI
    00801741168024
    PMA / PMN Number
    K082571
    Removal / Correction Number
    NA
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    NY, US
    Reporter Occupation
    OTHER HEALTH CARE PROFESSIONAL
    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 # (B)(4). THE PATIENT'S ATTORNEY ALLEGED A DEFICIENCY AGAINST THE DEVICE. ADDITIONAL INFORMATION HAS BEEN REQUESTED, BUT NOT YET RECEIVED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    330282 AVAULTA SOLO® SYNTHETIC SUPPORT SYSTEM - ANTERIOR AVAULTA SOLO® SYNTHETIC SUPPORT SYSTEM - ANTERIOR OTP C.R. BARD, INC. (COVINGTON) -1018233 NA CVRL0016 00801741168024

    Patients

    Seq Age Sex Outcome Treatment
    1 62 YR Female Required Intervention BOSTON SCIENTIFIC OBTRYX TRANSOBTURATOR, | LOT# OML7123110| MID-URETHRAL SLING SYSTEM, CAT# M0068505000, | LOT# OML7123110| BOSTON SCIENTIFIC OBTRYX TRANSOBTURATOR,| MID-URETHRAL SLING SYSTEM, CAT# M0068505000,