MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a consumer,health professional, report with the FDA on 2016-11-04 for SURESOUND SOUND12-923001-01 manufactured by Hologic, Inc.
[59182728]
The suresound is not being returned therefore, a failure analysis of the complaint device can not be completed. 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
[59182729]
Note: this report pertains to the first of two hologic devices used in the same procedure. See associated medwatch, manufacturer's report# 1222780-2016-00259. It was reported the physician performed a novasure endometrial ablation on (b)(6) 2016. The physician received several unsuccessful cavity integrity assessment (cia) tests using two disposable devices. The physician performed a laparoscopy and noted a perforation. On (b)(6) 2016, it was reported the patient was admitted into the hospital and discharged after two days. It is unknown if intervention was required. The patient returned to the office for follow up and is "doing well. " dilatation (not a hologic device) was 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
| Report Number | 1222780-2016-00263 |
| MDR Report Key | 6079181 |
| Report Source | CONSUMER,HEALTH PROFESSIONAL, |
| Date Received | 2016-11-04 |
| Date of Report | 2016-10-06 |
| Date of Event | 2016-10-04 |
| Date Mfgr Received | 2016-10-06 |
| Date Added to Maude | 2016-11-04 |
| 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 | 3 |
| Event Location | 3 |
| Manufacturer Contact | MS. SIDRA PIRACHA |
| Manufacturer Street | 250 CAMPUS DRIVE |
| Manufacturer City | MARLBOROUGH MA 01752 |
| Manufacturer Country | US |
| Manufacturer Postal | 01752 |
| Manufacturer Phone | 5082638884 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | SURESOUND |
| Generic Name | UTERINE SOUNDING DEVICE |
| Product Code | HHM |
| Date Received | 2016-11-04 |
| Catalog Number | SOUND12-923001-01 |
| Lot Number | UNKNOWN |
| Operator | PHYSICIAN |
| Device Availability | N |
| Device Eval'ed by Mfgr | R |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | HOLOGIC, INC |
| Manufacturer Address | 250 CAMPUS DRIVE MARLBOROUGH MA 01752 US 01752 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Hospitalization; 2. Required No Informationntervention | 2016-11-04 |