MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a other report with the FDA on 2020-01-08 for ARTISYN Y-SHAPED MESH UNKNOWN PRODUCT manufactured by Ethicon Inc..
[185898895]
(b)(4). To date, the device has not been returned. If the product is returned for evaluation, any further information derived from the evaluation will be submitted in a supplemental 3500a form.
Patient Sequence No: 1, Text Type: N, H10
[185898896]
It was reported by an attorney that the patient underwent a gynecological surgical procedure on (b)(6) 2011 and mesh was implanted, due to her pelvic organ prolapse. It was reported that she experienced multiple infections, erosion of mesh, pain, prolapse, incontinence, and multiple corrective surgeries. It was reported that the patient underwent a diagnostic cystoscopy on (b)(6) 2017. It was reported she underwent mesh removal procedure and a small bowel resection on (b)(6) 2018. No additional information was provided.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 2210968-2020-00200 |
| MDR Report Key | 9564217 |
| Report Source | OTHER |
| Date Received | 2020-01-08 |
| Date of Report | 2020-01-07 |
| Date Mfgr Received | 2020-01-06 |
| Date Added to Maude | 2020-01-08 |
| 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 | KARA DITTY-BOVARD |
| Manufacturer Street | P.O. BOX 151, ROUTE 22 WEST |
| Manufacturer City | SOMERVILLE NJ 08876 |
| Manufacturer Country | US |
| Manufacturer Postal | 08876 |
| Manufacturer Phone | 6107428552 |
| Manufacturer G1 | ETHICON INC.-GMBH |
| Manufacturer Street | P.O. BOX 1409 |
| Manufacturer City | NORDERSTEDT D22841 |
| Manufacturer Country | GM |
| Manufacturer Postal Code | D22841 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | ARTISYN Y-SHAPED MESH UNKNOWN PRODUCT |
| Generic Name | MESH, SURGICAL, SYNTHETIC, UROGYNECOLOGIC |
| Product Code | OTO |
| Date Received | 2020-01-08 |
| Catalog Number | UNK |
| Lot Number | UNK |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | N |
| Device Eval'ed by Mfgr | R |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | ETHICON INC. |
| Manufacturer Address | P.O. BOX 151, ROUTE 22 WEST SOMERVILLE NJ 08876 US 08876 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Required No Informationntervention | 2020-01-08 |