MAUDE Adverse Event Report: ASTORA WOMEN'S HEALTH LLC AMS IN-FAST BONE SCREW SYSTEM; SCREW, FIXATION, BONE

Device Problem Insufficient Information (3190)

Patient Problems Erosion (1750); Calcium Deposits/Calcification (1758); Death (1802); Fistula (1862); Micturition Urgency (1871); Incontinence (1928); Unspecified Infection (1930); Inflammation (1932); Pain (1994); Urinary Retention (2119); Urinary Tract Infection (2120); Abnormal Vaginal Discharge (2123); Urinary Frequency (2275); Discomfort (2330); Sleep Dysfunction (2517); Dysuria (2684)

Event Date 04/13/2006

Event Type  Death  

Event Description

It was reported by the plaintiff's attorney that the plaintiff experienced yeast infection, stress urinary incontinence, left lower quadrant pain, urinary retention, left flank discomfort, vaginal discharge, urge incontinence, hesitancy, dysuria, voiding dysfunction, urgency and frequency, urethral erosion, nocturia, urinary tract infection, urethral calcification, recurrent cystitis, and vaginal fistula.Furthermore, it was reported that the plaintiff died.No cause of death was reported.Related to manufacturer report #: 3011770902-2016-00240, 3011770902-2016-00242.

• Brand Name: AMS IN-FAST BONE SCREW SYSTEM
• Type of Device: SCREW, FIXATION, BONE
• Manufacturer (Section D): ASTORA WOMEN'S HEALTH LLC; 13200 pioneer trail; suite 100; eden prairie MN 55347
• Manufacturer (Section G): ASTORA WOMEN'S HEALTH LLC; 13200 pioneer trail; suite 100; eden prairie MN 55347
• Manufacturer Contact: erika a. merrick ; 13200 pioneer trail; suite 100; eden prairie, MN 55347 ; 9522383906
• MDR Report Key: 5660303
• MDR Text Key: 45320916
• Report Number: 3011770902-2016-00241
• Device Sequence Number: 1
• Product Code: HWC
• Combination Product (y/n): N
• PMA/PMN Number: NA
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: other
• Reporter Occupation: Other
• Type of Report: Initial,Followup
• Report Date: 05/03/2016

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 05/17/2016
• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: Yes
• Device Operator: Lay User/Patient
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: No
• Date Manufacturer Received: 05/17/2016
• Was Device Evaluated by Manufacturer?: Device Not Returned to Manufacturer
• Date Device Manufactured: 05/25/2001
• Is the Device Single Use?: Yes
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: Initial
• Patient Sequence Number: 1
• Patient Outcome(s): Death
• Patient Age: 71 YR
• Patient Weight: 70