FDA Adverse Event Injury Summary report: N

ESSURE

MDR report key: 9232406 · Received October 24, 2019

Report

Report Number
2951250-2019-10693
Event Type
Injury
Date Received
October 24, 2019
Report Date
October 24, 2019
Manufacturer
BAYER PHARMA AG
Product Code
HHS
UDI-DI
10888853003051
PMA / PMN Number
P020014
Adverse Event
Yes
Report Source
Manufacturer report
Reporter Location
BR
Reporter Occupation
OTHER

Narratives

Description of Event or Problem · 1

THIS SPONTANEOUS CASE WAS REPORTED BY A CONSUMER AND DESCRIBES THE OCCURRENCE OF PELVIC INFLAMMATORY DISEASE ('PELVIC INFLAMMATION') IN A (B)(6) YEAR-OLD FEMALE PATIENT WHO HAD ESSURE INSERTED. THE OCCURRENCE OF ADDITIONAL NON-SERIOUS EVENTS IS DETAILED BELOW. IN 2014, THE PATIENT HAD ESSURE INSERTED. ON AN UNKNOWN DATE, THE PATIENT EXPERIENCED PELVIC INFLAMMATORY DISEASE (SERIOUSNESS CRITERIA MEDICALLY SIGNIFICANT AND INTERVENTION REQUIRED), PELVIC PAIN ("PELVIC PAIN"), DYSPAREUNIA ("PAINFUL SEXUAL INTERCOURSE"), PAIN ("BODY ACHE"), HEADACHE ("HEADACHE"), ALOPECIA ("HAIR LOSS"), VISION BLURRED ("BLURRED VISION") AND PANIC REACTION ("PANIC SYNDROME"). ESSURE TREATMENT WAS NOT CHANGED. AT THE TIME OF THE REPORT, THE PELVIC INFLAMMATORY DISEASE, PELVIC PAIN, DYSPAREUNIA, PAIN, HEADACHE, ALOPECIA, VISION BLURRED AND PANIC REACTION OUTCOME WAS UNKNOWN. THE REPORTER CONSIDERED ALOPECIA, DYSPAREUNIA, HEADACHE, PAIN, PANIC REACTION, PELVIC INFLAMMATORY DISEASE, PELVIC PAIN AND VISION BLURRED TO BE RELATED TO ESSURE. NO LOT NUMBER OR DEVICE SAMPLE WAS RECEIVED IN THIS CASE. AT THIS TIME, WE HAVE NO INFORMATION SUGGESTING THAT THE DEVICE FAILED TO MEET ITS SPECIFICATIONS. WE WILL CONDUCT A REVIEW OF OUR COMPLAINTS RECORDS AND OTHER NON-CONFORMANCE DATA; SHOULD ANY NEW AND REPORTABLE INFORMATION BECOME AVAILABLE FROM OUR INVESTIGATION, THIS WILL BE PROVIDED IN A SUPPLEMENTARY REPORT.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1025561 ESSURE TRANSCERVICAL CONTRACEPTIVE TUBAL OCCLUSION DEVICE HHS BAYER PHARMA AG ESS305 10888853003051

Patients

Seq Age Sex Outcome Treatment
1 32 YR Other| R