BEUDAMED
    FDA Adverse Event Injury Summary report: N

    GYNECARE TVT RETROPUBIC SYSTEM

    MDR report key: 3242800 · Received July 23, 2013

    Report

    Report Number
    2210968-2013-14161
    Event Type
    Injury
    Date Received
    July 23, 2013
    Report Date
    July 15, 2013
    Manufacturer
    ETHICON INC.
    Product Code
    OTN
    PMA / PMN Number
    K012628
    Removal / Correction Number
    NA
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    OK, US
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 1

    (B)(4). IT WAS REPORTED BY AN ATTORNEY THAT THE PATIENT UNDERWENT A GYNECOLOGICAL PROCEDURE ON 5/5/06 AND A MESH WAS IMPLANTED. IT WAS REPORTED THAT PATIENT UNDERWENT LAPAROSCOPIC SUPRACERVICAL HYSTERECTOMY WITH LEFT SALPINGO-OOPHORECTOMY ON (B)(6) 2008, DUE TO CHRONIC PELVIC PAIN, MENOMETRORRHAGIA AND UTERINE FIBROIDS. IT WAS REPORTED THAT PATIENT UNDERWENT LAPAROSCOPY WITH RIGHT SALPINGO-OOPHORECTOMY ON (B)(6) 2009, DUE TO CHRONIC PELVIC PAIN WITH RIGHT OVARIAN CYST. NO ADDITIONAL INFORMATION WAS PROVIDED.

    Additional Manufacturer Narrative · 1

    (B)(4). NO CONCLUSION CAN BE DRAWN AT THIS TIME. SHOULD ADDITIONAL INFORMATION BE OBTAINED, A SUPPLEMENTAL 3500A FORM WILL BE SUBMITTED ACCORDINGLY.

    Additional Manufacturer Narrative · 1

    IT WAS REPORTED THAT THE PATIENT UNDERWENT A GYNECOLOGICAL PROCEDURE AND MESH WAS IMPLANTED ALONG WITH CONCURRENT CYSTOSCOPY DUE TO SUI.

    Description of Event or Problem · 1

    IT WAS REPORTED THAT THE PATIENT UNDERWENT A GYNECOLOGICAL PROCEDURE ON (B)(6) 2006 AND MESH WAS IMPLANTED INTO THE PATIENT. IT IS ALSO REPORTED THAT THE PATIENT EXPERIENCED PAIN, EROSION OF INTERNAL TISSUES, AND HAS UNDERGONE ADDITIONAL SURGERIES AND REVISIONARY PROCEDURES. NO ADDITIONAL INFORMATION IS PROVIDED AT THIS TIME.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    343339 GYNECARE TVT RETROPUBIC SYSTEM MESH, SURGICAL, SYNTHETIC, UROGYNECOLOGIC OTN ETHICON INC. UNK 1319000

    Patients

    Seq Age Sex Outcome Treatment
    1 Required Intervention