(b)(4).An examination of the returned device found that in the middle of the mesh, the mesh was stretched and torn/split down the middle.Its corresponding leader loop was not cut, indicating that the mesh tore away from the leader loop.No damage was noted to the delivery device.A review of the device history record (dhr) confirmed that the device met all material, assembly, and product specifications at the time of release to distribution.It is likely that operational factors, such as user handling/technique, device tensioning/adjustment, and patient anatomy, contributed to the reported complaint.It is likely that excessive force was also encountered.Therefore, the most probable cause for this complaint is adverse event related to procedure, which indicates that the adverse event occurred during the procedure and the device had no influence on event.
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Note: this manufacturer report pertains to the second of two devices used during the procedure.It was reported to boston scientific corporation that two obtryx ii system - halo devices were used during an insertion of sub-urethral sling procedure performed on (b)(6) 2018.According to the complainant, during the procedure, for the first device, the mesh snapped from arms during pulling of the sleeves.A second device was opened and the same issue occurred.The procedure was completed with an advantage fit system.There were no patient complications reported as a result of this event.This event has been deemed reportable based on the investigation results: the mesh was stretched and torn/split down the middle.
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