MAUDE Adverse Event Report: BAYER PHARMA AG ESSURE; TRANSCERVICAL CONTRACEPTIVE TUBAL OCCLUSION DEVICE

Model Number ESS205

Device Problems Adverse Event Without Identified Device or Use Problem (2993); Appropriate Term/Code Not Available (3191)

Patient Problem Insufficient Information (4580)

Event Type  Injury  

Event Description

This spontaneous case was originally reported by a lawyer on behalf of a consumer and describes the occurrence of medical device removal ("foreign body material has been removed") in a female patient who had essure (ess205) inserted (lot no.508905).Additional non-serious events are detailed below.There was no information on the patient's medical history or concurrent conditions.In (b)(6) 2006, the patient had essure (ess205) inserted.An unknown time later she experienced injury ("injury person") and underwent medical device removal (seriousness criterion intervention required).The patient was treated with surgery (essure removal).At the time of the report, the outcomes for these events were unknown.The reporter considered injury and medical device removal to be related to essure (ess205) administration.The reporter commented: various physical symptoms developed after this treatment.Since then, i have had follow-up treatments and the foreign-body material has been removed.As a result of the symptoms, i am hindered in my normal daily functioning, and i suffer damages.Lot number: 508905 manufacturing date:2005-10 expiration date: 2007-09.Quality-safety evaluation of ptc: for essure (ess205): unable to confirm complaint.The most recent follow-up information incorporated above includes data received on: 10-aug-2022: previously reported event injury was updated to medical device removal; case upgraded to serious incident; reporter's information and patient's initial updated; essure model changed to ess205 (from ess305) and insertion date changed to (b)(6) 2006 (from (b)(6) 2006).We received a lot number in this case.A technical investigation was conducted, including a batch review, and a review of complaint records and other relevant data; should any new and reportable information become available from our investigation, this will be provided in a supplementary report.

Manufacturer Narrative

This spontaneous case was originally reported by a lawyer on behalf of a consumer and describes the occurrence of medical device removal ("foreign body material has been removed") in a female patient who had essure (ess205) inserted (lot no.508905).There was no information on the patient's medical history or concurrent conditions.In (b)(6) 2006, the patient had essure (ess205) inserted.An unknown time later she underwent medical device removal (seriousness criterion intervention required).The patient was treated with surgery (essure removal).At the time of the report, the outcome of the event was unknown.The reporter considered medical device removal to be related to essure (ess205) administration.The reporter commented: various physical symptoms developed after this treatment.Since then, i have had follow-up treatments and the foreign-body material has been removed.As a result of the symptoms, i am hindered in my normal daily functioning, and i suffer damages.Lot number: 508905, manufacturing date: 2005-10 and expiration date: 2007-09.Quality-safety evaluation of ptc: for essure (ess205): no defect could be confirmed by the manufacturer.All component batches used for manufacturing of this product batch fulfilled the set specifications.Batch documentation did not reveal any deviations during the manufacturing process that could have caused the described complaint reason.Trend analyses of complaints are reviewed regularly, no signal was observed with regard to the reported complaint reason.The risk management file was reviewed and an update was not deemed required.A technical investigation of the complaint sample could not be conducted, as no sample was available.The most recent follow-up information incorporated above includes data received on: 17-aug-2022: quality safety evaluation of ptc.We received a lot number in this case.A technical investigation was conducted, including a batch review, and a review of complaint records and other relevant data; should any new and reportable information become available from our investigation, this will be provided in a supplementary report.

• Brand Name: ESSURE
• Type of Device: TRANSCERVICAL CONTRACEPTIVE TUBAL OCCLUSION DEVICE
• Manufacturer (Section D): BAYER PHARMA AG; müllerstr. 178; berlin, 13353 ; GM 13353
• Manufacturer (Section G): BAYER PHARMA AG; müllerstr. 178; berlin, 13353 ; GM 13353
• Manufacturer Contact: k shaw lamberson ; 100 bayer blvd, p.o. box 915; whippany, nj
• MDR Report Key: 15229056
• MDR Text Key: 297949366
• Report Number: 2951250-2022-00984
• Device Sequence Number: 1
• Product Code: HHS
• UDI-Device Identifier: 10888853003051
• UDI-Public: (01)10888853003051
• Combination Product (y/n): N
• Reporter Country Code: NL
• PMA/PMN Number: P020014
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Other,Foreign,Consumer
• Reporter Occupation: Other
• Type of Report: Initial,Followup
• Report Date: 08/17/2022

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 08/15/2022
• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: No
• Device Operator: Health Professional
• Device Expiration Date: 09/01/2007
• Device Model Number: ESS205
• Device Lot Number: 508905
• Is the Reporter a Health Professional?: No
• Date Manufacturer Received: 08/17/2022
• Was Device Evaluated by Manufacturer?: No
• Date Device Manufactured: 10/01/2005
• 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): Required Intervention
• Patient Sex: Female