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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: C.R. BARD, INC. (COVINGTON) -1018233 AJUST® ADJUSTABLE SINGLE-INCISION SLING

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C.R. BARD, INC. (COVINGTON) -1018233 AJUST® ADJUSTABLE SINGLE-INCISION SLING Back to Search Results
Catalog Number BRD705SI
Device Problem Adverse Event Without Identified Device or Use Problem (2993)
Patient Problems Abdominal Pain (1685); Adult Respiratory Distress Syndrome (1696); Anemia (1706); Arthritis (1723); Rheumatoid Arthritis (1724); Erosion (1750); Bronchitis (1752); Bruise/Contusion (1754); Chest Pain (1776); Cyst(s) (1800); Dehydration (1807); Diarrhea (1811); Dysphagia/ Odynophagia (1815); Dyspnea (1816); Ecchymosis (1818); Emotional Changes (1831); Pulmonary Emphysema (1832); Fatigue (1849); Fever (1858); Fistula (1862); Micturition Urgency (1871); Gastritis (1874); Headache (1880); Pyrosis/Heartburn (1883); Hepatitis (1897); High Blood Pressure/ Hypertension (1908); Hyperventilation (1910); Low Blood Pressure/ Hypotension (1914); Incontinence (1928); Unspecified Infection (1930); Inflammation (1932); Memory Loss/Impairment (1958); Nausea (1970); Oversedation (1990); Pain (1994); Scar Tissue (2060); Tachycardia (2095); Transient Ischemic Attack (2109); Urinary Retention (2119); Urinary Tract Infection (2120); Abnormal Vaginal Discharge (2123); Blurred Vision (2137); Vomiting (2144); Burning Sensation (2146); Immunodeficiency (2156); Chronic Obstructive Pulmonary Disease (COPD) (2237); Stenosis (2263); Urinary Frequency (2275); Anxiety (2328); Discomfort (2330); Depression (2361); Sore Throat (2396); Respiratory Tract Infection (2420); Obstruction/Occlusion (2422); Respiratory Failure (2484); Skin Tears (2516); Sleep Dysfunction (2517); Confusion/ Disorientation (2553); Hematuria (2558); Bronchospasm (2598); Weight Changes (2607); Intermenstrual Bleeding (2665); Dysuria (2684); Foreign Body In Patient (2687); Fibrosis (3167); Cancer (3262); Constipation (3274); Dyspareunia (4505)
Event Type  Injury  
Manufacturer Narrative
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 ajust¿ sling system may include, but are not limited to: postoperative hematoma, seroma, abscess or fistula formation, or scarring which may occur following the implant procedure.Urinary retention, bladder outlet obstruction and other voiding dysfunctions.These conditions may be associated with over-correction/typically too much tension placed on the implant.Perforations or lacerations of vessels, nerves, bladder, bowel, urethra, vagina, 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 incontinence." (b)(4).
 
Event Description
The patient's attorney alleged a deficiency against the device.Additional information has been requested, but not yet received.Product was used for therapeutic treatment.Per additional information received the patient has experienced pain, erosion, extrusion, unspecified urinary problems, unspecified bowel problems, recurrence, bleeding, dyspareunia (pain during intercourse), emotional/psychological injury, upper respiratory illness exacerbated by exertion/coughing, productive cough, acute bronchitis, rales/crackles bilateral upper lobes, severe pain in left hand/wrist injured during fall, limited range of motion of left wrist/hand secondary to pain, ecchymoses (bruising), swelling in left hand, strain left wrist/hand, soft tissue swelling seen on x-rays of left wrist, synovial fluid aspirated from left knee, fatigue, hepatitis c virus (infection), elevated white blood cell count, elevated serum glucose, elevated liver enzymes, nausea, vomiting, severe left-sided migraine headache exacerbated by light/noise (headache), palpitations, chronic back pain, diarrhea, blurred vision, photophobia, sensitivity to light, anxiety, weakness, ultrasound-guided liver biopsy, melena, irregular heart rate, sore throat, frequency, depression, grade iv hepatic fibrosis (fibrosis), moderate chronic hepatic inflammation (inflammation), discomfort, tenderness at liver biopsy site, chronic obstructive pulmonary disease, shortness of breath, reports gurgling from lungs, chest pain/pressure, abdominal pain, diminished breath sounds, sinus tachycardia, abnormal electrocardiogram (inferior infarct, probable lateral infarct/old, multiple ventricular premature complexes), right rib pain, pneumonia, underweight (weight fluctuations), scarring in lungs (scarring), nondisplaced right seventh rib fracture, partially healed right sixth rib fracture, fever, productive cough, difficulty breathing (respiratory distress), bronchospasm, calf/leg pain, hyperventilation, reflux esophagitis, sharp midsternal pain, confusion, heartburn, panic attacks, epigastric pain, chronic hypoxic respiratory failure (respiratory failure), insomnia (sleep disturbances), memory issues, emphysema, urinary tract infections, kidney stones, anemia, dysphagia, bilateral knee pain (joint pain), left hip pain (joint pain), generalized weakness, vaginal/pelvic pain, worsening incontinence, multiple bruises and skin tears in nasal mucosa (tearing), bruising and skin tears to both arms (bruises, skin tears), dysuria, frequency, urgency, diffuse abdominal pain, burning upon urination (burning sensation), bladder swelling (swelling), mucous retention cysts left maxillary antrum (cysts), transient ischemic attacks (tia), flashes of light, confusion, osteopenia, extensive right sphenoid sinus mucosal thickening/sphenoid sinus disease hematuria, low platelet count, and required additional non-surgical intervention.Per additional information received, the patient has experienced burning in vagina (burning sensation), chronic pain, bladder pain, sensation of bladder swelling, dyspareunia, bleeding with sex (blood loss), going to bathroom all of the time (urinary frequency), bladder does not empty all the way (urinary retention), recurrent bladder infections, pain with urination (dysuria), stress/urge urinary incontinence, urethral stenosis, bowel obstruction, crohns disease, irritable bowel syndrome, ulcerative colitis, diverticulitis, constipation, lower abdominal pain, anxiety, thickening of the colon, nausea, vomiting, and required additional surgical and non surgical interventions.Per additional information received via medical records on august 29, 2018, the patient has experienced vaginal pain, pelvic pain, dysuria, frequency, urgency burning, upper abdominal pain, mild constipation, nausea, vomiting, lower abdominal pain, stress urinary incontinence, urge urinary incontinence, questionable stool in her vagina, and urethral stenosis.On (b)(6) 2015, (b)(6)i, md noted a possible enterovaginal or colovaginal fistula that could be related to either crohns disease or prior bladder sling procedure; it is unknown if an enterovaginal or colovaginal fistula was definitively diagnosed.She required a surgical intervention consisting of cystoscopy with urethral dilation on (b)(6) 2015.Per the pfs, the patient alleged she also experienced a bowel obstruction, ulcerative colitis, diverticulitis, dyspareunia, hypotension, pelvic tumors/fibroids, recurrent bladder infections, and urinary retention.Per additional information received via medical records on october 4, 2018, the patient has experienced abdominal pain, constipation, headache, nausea, vomiting, fistula, anxiety, stress/urge urinary incontinence, urethral stenosis, foreign body sensation, foreign body in patient, vaginal discharge, infection, vaginitis, discharge, urgency, leakage, nocturia, urinary tract infection, stool in vagina, bloody diarrhea, blood loss, hemorrhoids, additional surgical and nonsurgical interventions.Per additional information received, the patient has experienced mesh erosion, tissue erosion, exposed and protruding mesh, pain, bleeding, infection and dyspareunia.
 
Event Description
Per additional information received on 15nov2021, the patient has experienced swollen bladder, weakness, irritable bowel syndrome, gastroesophageal reflux, kidney stones, rheumatoid arthritis, light flashing, episode of confusion, osteoporosis, hepatocellular disease, elevated heart rate, shortness of breath, gastroenteritis, mild dehydration, high dose steroid dependence, chronic immunosuppression, polycythemia, left knee osteoarthritis, gastritis, dysphagia, pain during sexual intercourse, bleeding, bladder problems, inability to empty the bladder, bowel obstruction, brain and lung cancer, ulcerative colitis, crohn¿s disease, diabetes, diverticulitis, hypotension, pelvic tumors, recurrent bladder infections, pain while urination, mixed urinary incontinence, celiac artery occlusive disease and required additional surgical and non-surgical interventions.
 
Manufacturer Narrative
1724, 1816, 1807="nl".H11: section a through f - the information provided by bd 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 bd.
 
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Brand Name
AJUST® ADJUSTABLE SINGLE-INCISION SLING
Type of Device
AJUST® ADJUSTABLE SINGLE-INCISION SLING
Manufacturer (Section D)
C.R. BARD, INC. (COVINGTON) -1018233
8195 industrial blvd
covington GA 30014
Manufacturer (Section G)
C.R. BARD, INC. (COVINGTON) -1018233
8195 industrial blvd
covington GA 30014
Manufacturer Contact
yonic anderson
8195 industrial blvd
covington, GA 30014
7707846100
MDR Report Key11831687
MDR Text Key250861615
Report Number1018233-2021-80041
Device Sequence Number1
Product Code PAH
UDI-Device Identifier00801741168017
UDI-Public(01)00801741168017
Combination Product (y/n)N
Reporter Country CodeUS
PMA/PMN Number
K092607
Number of Events Reported1
Summary Report (Y/N)N
Report Source Manufacturer
Source Type Other
Reporter Occupation Non-Healthcare Professional
Type of Report Initial,Followup
Report Date 11/19/2021
1 Device was Involved in the Event
1 Patient was Involved in the Event
Date FDA Received05/17/2021
Is this an Adverse Event Report? Yes
Is this a Product Problem Report? No
Device Operator Health Professional
Device Expiration Date03/31/2014
Device Catalogue NumberBRD705SI
Device Lot NumberHUWB0996
Was Device Available for Evaluation? No
Was the Report Sent to FDA? No
Device Age2 MO
Event Location Hospital
Date Manufacturer Received11/15/2021
Was Device Evaluated by Manufacturer? Device Not Returned to Manufacturer
Date Device Manufactured03/09/2012
Is the Device Single Use? Yes
Is This a Reprocessed and Reused Single-Use Device? No
Type of Device Usage Initial
Patient Sequence Number1
Treatment
UNK.
Patient Outcome(s) Required Intervention;
Patient Age51 YR
Patient SexFemale
Patient Weight49 KG
Patient EthnicityNon Hispanic
Patient RaceWhite
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