MAUDE MDR 3841808

MDR report key
3841808
Report number
1018233-2014-00135
Event key
0
Event type
3
Date received
2014-05-30
Adverse event
3
Product problem
3
Patients in event
0
Reporter occupation
600
Health professional
3
Initial report to FDA
3
Event location
3

Manufacturer Contact#

Contact
MS ANGELA ROBINSON
Address
8195 INDUSTRIAL BLVD COVINGTON GA 30014 US
Phone
770-770-7707
Report source
M
Manufacturer link flag
Y

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1ALYTE Y-MESH GRAFTALYTE Y-MESH GRAFTBARD SHANNON LIMITEDOTONAY500HUWC0343R N

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12014-05-3001. R

Event Narratives#

D

Patient 1

PER ADDITIONAL INFORMATION RECEIVED, THE PATIENT HAS EXPERIENCED FREQUENT PREMATURE VENTRICULAR CONTRACTIONS FOLLOWED BY RETROSTERNAL CHEST PAIN WITH SLIGHT ST-SEGMENT CHANGES ON HER 12-LEAD ELECTROCARDIOGRAM POSTOPERATIVELY, HYPOTENSION, CONSTIPATION, DIVERTICULOSIS COLI, 1.8 CM HEPATIC LIPOMA, MILD BILIARY DILATATION LIKELY RELATED TO CHOLECYSTECTOMY AND FAT-CONTAINING MIDLINE HERNIAS, MIXED URGE AND STRESS URINARY INCONTINENCE, LOWER ABDOMINAL PAIN, NAUSEA, ACUTE CYSTITIS, AND MENOPAUSAL SYMPTOMS, PAIN, INFECTION, BLEEDING, AND DYSPAREUNIA.

N

Patient 1

(B)(4) 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 EVENTS: COMPLICATIONS ASSOCIATED WITH THE PROPER IMPLANTATION OF THE ALYTE Y-MESH GRAFT MAY INCLUDE, BUT ARE NOT LIMITED TO THOSE TYPICALLY ASSOCIATED WITH SURGICALLY IMPLANTABLE MATERIALS INCLUDING: ? POSTOPERATIVE HEMATOMA, SEROMA, ABSCESS OR FISTULA FORMATION, OR SCARRING WHICH MAY OCCUR FOLLOWING THE IMPLANT PROCEDURE. ? URINARY RETENTION, BLADDER OUTLET OBSTRUCTION AND OTHER VOIDING AND DEFECATORY DYSFUNCTIONS. THESE CONDITIONS MAY BE ASSOCIATED WITH OVER-CORRECTION/TOO MUCH TENSION PLACED ON THE IMPLANT. ? PERFORATIONS OR LACERATIONS OF VESSELS, NERVES, BLADDER, BOWEL, URETHRA, RECTUM, OR ANY VISCERA, WHICH MAY OCCUR DURING THE IMPLANTATION PROCEDURE. ? IRRITATION AT THE OPERATIVE WOUND SITE WHICH MAY ELICIT A FOREIGN BODY RESPONSE THAT LEADS TO WOUND DEHISCENCE, INFLAMMATION AND/OR INFECTION. ? EXTRUSION THROUGH VAGINAL EPITHELIUM OR EROSION INTO SURROUNDING VISCERA AND/OR MUCOSA. ? INFLAMMATION, SENSITIZATION, PAIN, DYSPAREUNIA, SCARIFICATION, CONTRACTION, DEVICE MIGRATION AND FAILURE OF THE PROCEDURE RESULTING IN RECURRENCE OF VAGINAL WALL PROLAPSE. ? URINARY INCONTINENCE (STRESS AND URGE). (B)(4).

N

Patient 1

(B)(4). ORIGINAL REPORTING TIME FRAME (B)(4) 2014. THE INFORMATION PROVIDED BY BARD REPRESENTS ALL OF THE KNOWN INFORMATION AT THIS TIME. DESPITE GOOD FAITH EFFORTS TO OBTAIN ADDITIONAL INFORMATION, THE COMPLAINANT / REPORTER WAS UNABLE OR UNWILLING TO PROVIDE ANY FURTHER PATIENT, PRODUCT, OR PROCEDURAL DETAILS TO BARD.

N

Patient 1

(B)(4). ORIGINAL REPORTING TIME FRAME MARCH 1, 2014 TO APRIL 30, 2014. THE INFORMATION PROVIDED BY BARD REPRESENTS ALL OF THE KNOWN INFORMATION AT THIS TIME. DESPITE GOOD FAITH EFFORTS TO OBTAIN ADDITIONAL INFORMATION, THE COMPLAINANT / REPORTER WAS UNABLE OR UNWILLING TO PROVIDE ANY FURTHER PATIENT, PRODUCT, OR PROCEDURAL DETAILS TO BARD.