BEUDAMED
    FDA Adverse Event Injury Summary report: N

    AVAULTA SOLO SYNTHETIC SUPPORT SYSTEM - POSTERIOR

    MDR report key: 3240041 · Received July 18, 2013

    Report

    Report Number
    1018233-2013-02869
    Event Type
    Injury
    Date Received
    July 18, 2013
    Report Date
    June 18, 2013
    Manufacturer
    BARD SHANNON LTD
    Product Code
    FTL
    PMA / PMN Number
    K082571
    Removal / Correction Number
    NA
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    TX, US
    Reporter Occupation
    ATTORNEY

    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, WHICH MAY OCCUR DURING NEEDLE PASSAGE." (B)(4).

    Description of Event or Problem · 1

    COMPLAINT # (B)(6). THE PT'S ATTORNEY ALLEGED A DEFICIENCY AGAINST THE DEVICE. ADDITIONAL INFO HAS BEEN REQUESTED BUT NOT YET RECEIVED. ASSOCIATED MDR #S: 1018233-2013-02871 AND 1018233-2013-02870.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    333438 AVAULTA SOLO SYNTHETIC SUPPORT SYSTEM - POSTERIOR FTL BARD SHANNON LTD NA HUSL0148

    Patients

    Seq Age Sex Outcome Treatment
    1 70 YR Required Intervention LOT# HUSI2213| PRODUCT# 486100, LOT# HUSK0698| PELVITEX POLYPROPYLENE MESH: PRODUCT#486015,| AVAULTA SOLO SYNTHETIC SUPPORT SYSTEM - ANTERIOR| LOT# PIK00167| ALIGN RS URETHRAL SUPPORT SYSTEM: PRODUCT#BRD300RS