MAUDE Adverse Event Report: ETHICON INC. TVT EXACT RETROPUBIC SYSTEM; MESH, SURGICAL, SYNTHETIC, UROGYNECOLOGIC

Catalog Number TVTRL

Device Problem Adverse Event Without Identified Device or Use Problem (2993)

Patient Problems Hemorrhage/Bleeding (1888); Incontinence (1928); Pain (1994); Urinary Tract Infection (2120)

Event Date 11/15/2023

Event Type  Injury  

Event Description

It was reported that a patient underwent a sling procedure on (b)(6) 2023 and mesh was implanted.On (b)(6) 2023, mild urinary tract infection symptoms were noted.This event was resolved as of 04 dec 2023 and reported as unlikely related to the study device, but possibly related to the study procedure.Also on (b)(6) 2023, moderate vaginal bleeding was noted.The patient was examined in the operating room under anesthesia and the event was recovered as of (b)(6) 2023.The vaginal bleeding was reported as not related to the study device, but having a causal relationship with the study procedure.On (b)(6) 2023, mild abdominal pain was noted.This was resolved as of (b)(6) 2023 and also reported as not related to the study device, but having a causal relationship with the study procedure.On (b)(6) 2024, mild stress incontinence and fecal smearing were noted.Unspecified drug therapy was provided, but the events have not been resolved.The stress incontinence was reported as possibly related to the study device and study procedure.The fecal smearing was reported as unlikely related to the study device or study procedure.Additional information has been requested.

Manufacturer Narrative

(b)(4).This report is being submitted pursuant to the provisions of 21 cfr, part 803.This report may be based on information which has not been investigated or verified prior to the required reporting date.This report does not reflect a conclusion by ethicon inc, or its employees that the report constitutes an admission that the product, ethicon inc, or its employees caused or contributed to the potential event described in this report.If information is obtained that was not available for the initial report, a follow-up report will be filed as appropriate.Additional information was requested and the following was obtained: please provide the patient's demographic information including age, gender, weight, bmi at the time of index procedure: 72, female, 53kg, 20.06.Date and name of index surgical procedure? sling operation for stress incontinence the diagnosis and indication for the index surgical procedure? stress incontinence were any concomitant procedures performed? yes.See edc.What symptoms did the patient experience following the index surgical procedure? onset date? (b)(6) 2023 ¿ minimal pain and bright red blood.Other relevant patient history/concomitant medications? n/a.What was the initial approach for the index surgical procedure? (open, laparoscopic or other)? vaginal.What was the source and triggering event of bleeding? two broad, raw.Areas/abrasions noted on the anterior and posterior vaginal walls ¿ sling incisions were healed ¿ from concomitant procedure.How was the bleeding treated? pt taken to operating room and bleeding controlled with 3 2-0 polysorb stitches.Please describe any medical/surgical intervention required including results/findings.Exam under anesthesia ¿ found source of bleeding.Were there any deficiencies or anomalies noted with the device prior to, during or after the procedure? no.What is the physician¿s opinion as to the etiology of or contributing factors to this event? eroded suture.What is the patient's current status? recovered.Product code and lot number? tvtrl - 3944398.To date it has been reported that the device will not be returned.If the device or further details are received at a later date a supplemental medwatch will be sent.H6 component code: g07002 ¿ device not returned.

Manufacturer Narrative

(b)(4).This report is being submitted pursuant to the provisions of 21 cfr, part 803.This report may be based on information which has not been investigated or verified prior to the required reporting date.This report does not reflect a conclusion by ethicon inc, or its employees that the report constitutes an admission that the product, ethicon inc, or its employees caused or contributed to the potential event described in this report.If information is obtained that was not available for the initial report, a follow-up report will be filed as appropriate.A review of the batch manufacturing records was conducted, and no related non-conformances were identified.

• Brand Name: TVT EXACT RETROPUBIC SYSTEM
• Type of Device: MESH, SURGICAL, SYNTHETIC, UROGYNECOLOGIC
• Manufacturer (Section D): ETHICON INC.; 1000 route 202; raritan NJ 08869
• Manufacturer (Section G): ETHICON SARL-NEUCHATEL; puits-godet 20; neuchatel 2000 ; SZ 2000
• Manufacturer Contact: elba bello ; 1000 route 202; raritan, NJ 08869 ; 9083863534
• MDR Report Key: 18886074
• MDR Text Key: 337441893
• Report Number: 2210968-2024-02908
• Device Sequence Number: 1
• Product Code: OTN
• UDI-Device Identifier: 10705031062375
• UDI-Public: 10705031062375
• Combination Product (y/n): N
• Reporter Country Code: US
• PMA/PMN Number: K132054
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Study,Health Professional
• Reporter Occupation: Other
• Type of Report: Initial,Followup

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 03/12/2024
• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: No
• Device Operator: Health Professional
• Device Expiration Date: 04/30/2024
• Device Catalogue Number: TVTRL
• Device Lot Number: 3944398
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: No
• Date Manufacturer Received: 03/24/2024
• Was Device Evaluated by Manufacturer?: Device Not Returned to Manufacturer
• Date Device Manufactured: 05/24/2023
• 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 Age: 72 YR
• Patient Sex: Female
• Patient Weight: 53 KG