MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 05,06,07 report with the FDA on 2012-12-28 for SURESOUND SOUND12-923001-01 manufactured by Hologic.
[21108519]
Note: this report pertains to the second of two hologic devices used in the same procedure. See associated medwatch, mfr? S report number: 1222780-2012-00265. Prior to a novasure endometrial ablation, the physician performed a hysteroscopy and curettage to remove polyps in the uterine cavity. During the novasure procedure, the physician received several unsuccessful cavity integrity assessment (cia) tests, with three devices. The physician performed another hysteroscopy and no perforation was observed. The physician noted fluid in the uterine cavity. The physician thought that? Possibly there was damage done during the curettage and a perforation occurred?. The procedure was aborted. On (b)(6) 2012, it was reported no intervention was required. The patient was discharged home and is currently doing? Fine?. A hysteroscopy, dilatation and curettage (d&c, sounding with a metal sound (not hologic devices) were performed prior to the attempted ablation. It is not known when this perforation occurred or what instrument may have been the cause.
Patient Sequence No: 1, Text Type: D, B5
[21159001]
Lot number of the suresound not provided by the complainant, therefore, the expiration date is not known. The suresound is not being returned therefore, a failure analysis of the complaint device cannot be completed. Lot number of the suresound not provided by the complainant, therefore, the manufacture date is not known. Device history record (dhr) review could not be conducted for the suresound as a lot number was not provided by the complainant. According to the instructions for use (ifu) adverse events: potential adverse events include, but are not limited to perforation of the uterine wall. (b)(4).
Patient Sequence No: 1, Text Type: N, H10
| Report Number | 1222780-2012-00266 |
| MDR Report Key | 2893368 |
| Report Source | 05,06,07 |
| Date Received | 2012-12-28 |
| Date of Report | 2012-11-28 |
| Date of Event | 2012-11-28 |
| Date Facility Aware | 2012-11-28 |
| Date Mfgr Received | 2012-11-28 |
| Date Added to Maude | 2013-01-03 |
| Event Key | 0 |
| Report Source Code | Manufacturer report |
| Manufacturer Link | Y |
| Number of Patients in Event | 0 |
| Adverse Event Flag | 3 |
| Product Problem Flag | 3 |
| Reprocessed and Reused Flag | 3 |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 0 |
| Event Location | 0 |
| Manufacturer Contact | CRAIG CALLAHAN, MGR |
| Manufacturer Street | 250 CAMPUS DRIVE |
| Manufacturer City | MARLBOROUGH MA 01752 |
| Manufacturer Country | US |
| Manufacturer Postal | 01752 |
| Manufacturer Phone | 5082638859 |
| Manufacturer G1 | HOLOGIC |
| Manufacturer Street | 250 CAMPUS DRIVE |
| Manufacturer City | MARLBOROUGH MA 01752 |
| Manufacturer Country | US |
| Manufacturer Postal Code | 01752 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | SURESOUND |
| Product Code | HHM |
| Date Received | 2012-12-28 |
| Model Number | NA |
| Catalog Number | SOUND12-923001-01 |
| Lot Number | UNK |
| ID Number | NA |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | N |
| Device Age | NA |
| Device Eval'ed by Mfgr | R |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | HOLOGIC |
| Manufacturer Address | MARLBOROUGH MA 01752 US 01752 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Other | 2012-12-28 |