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Model Number ESS305
Device Problem Migration or Expulsion of Device (1395)
Patient Problems Death, Intrauterine Fetal (1855); Fever (1858); Internal Organ Perforation (1987); Perforation (2001); Pregnancy (3193)
Event Date 01/01/2013
Event Type  Injury  
Event Description
This is a spontaneous case report received from a female consumer of unspecified age via regulatory authority (case# mw5036798) in united states on 04-aug-2014 who had essure (fallopian tube occlusion insert) inserted. On (b)(6) 2011, essure was inserted. In 2012, she became pregnant. In 2013, she had to deliver her son, but he had already died in utero three to four days prior (please refer to case number (b)(4)). In 2013, she went back in for surgery to have fallopian tubes removed. Upon awakening she was informed the essure on one side had migrated and perforated her uterus with a possibility of later puncturing her bowel. Therefore, she needed a hysterectomy. She went back under to have the hysterectomy, however, leaving ovaries. Three days later she was back in the hospital with a fever of 103. Nothing came of the fever. The date (b)(6) 2013 was reported as explant date. Death and life-threatening were selected by consumer as event report type and event outcome, respectively. However, it was not specified which event. No further information was provided. Follow-up information was received on 18-aug-2014: the required number of follow-up attempts has been made, with no response to date. Ptc investigation result was received on 22-aug-2014. This adverse event report is related to a product technical complaint (ptc). The bayer reference number for the ptc report is: ptc local number (b)(4) and ptc global number (b)(4). Final assessment: since no product was returned to us for investigation, we were unable to perform an investigation of the actual device involved in this complaint. Typically, we would inspect the micro-insert to confirm that all parts are accounted for and inspect the device to look for any manufacturing deficiencies. Since we have no valid lot number for this case, we were unable to conduct a review of the manufacturing batch record. We are unable to confirm any quality defect or device malfunction at this time. Medical assessment: the reported events are not indicative of a quality defect per se. In this particular case a lack of efficacy (pregnancy) was reported. A contraceptive failure may occur under the use of any contraceptive and is not indicative of a quality deficit per se. No batch number was reported. Without this information neither a technical batch evaluation nor a batch signal cluster review in the gpv database for a more detailed statistical medical evaluation is possible. No complaint sample was provided for further technical investigation. In summary, there is no suspicion of a quality defect based on the limited available information. Company causality comment: this non-medically confirmed, spontaneous case report, refers to a female consumer who had essure (fallopian tube occlusion insert) inserted; experienced a pregnancy with essure (device ineffective) and had to deliver her son who died in utero 3-4 days prior. She also stated that essure migrated and perforated uterus with possibility of bowel puncture. She was submitted to fallopian tubes removal and hysterectomy; and after this surgery was hospitalized due to fever. All above reported events, with exception of pregnancy, were considered serious (life-threatening- deliver of dead son, medical significance-perforation and hospitalization-fever) and incidents (required interventions/hospitalization). They are listed according to reference safety information for essure; except for fever and had to deliver her son who died in utero 3-4 days prior which are unlisted. Unintended pregnancies may occur during any contraceptive use and have been reported in women with essure micro-inserts in place. In this particular case the consumer stated that she had to deliver her son who died in uterus, this event, interpreted as a fetal death was considered as related to essure, as a mechanical interference between the suspect insert and the developing pregnancy cannot be excluded. Regarding the event essure migrated and perforated uterus with possibility of bowel puncture; the perforation of the uterus, fallopian tubes and internal bodily structures may occur during essure therapy due to insert migration or during insertion procedure; therefore, this event was considered as related to essure. For the reported fever, as limited information was provided, causality cannot be assessed. According to product technical complaint investigation results, there is no suspicion of a quality defect based on the limited available information.
Manufacturer Narrative
Data correction for us reporting: the code knh was replaced with hhs.
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Brand NameESSURE
Manufacturer (Section D)
müllerstr. 178
berlin, CA 13353
GM 13353
Manufacturer (Section G)
müllerstr. 178
berlin, CA 13353
GM 13353
Manufacturer Contact
k shaw lamberson
100 bayer blvd.
p.o. box 915
whippany, NJ 07981-0915
MDR Report Key4051818
MDR Text Key4814218
Report Number2951250-2014-00352
Device Sequence Number1
Product Code HHS
Combination Product (y/n)N
Reporter Country CodeUS
PMA/PMN Number
Number of Events Reported1
Summary Report (Y/N)N
Report Source Manufacturer
Source Type Other,Consumer,consumer,other
Reporter Occupation
Type of Report Initial,Followup
Report Date 01/19/2017
1 Device was Involved in the Event
1 Patient was Involved in the Event
Date FDA Received09/02/2014
Is this an Adverse Event Report? Yes
Is this a Product Problem Report? Yes
Device Operator
Device Model NumberESS305
Was Device Available for Evaluation? No
Is the Reporter a Health Professional? No
Was the Report Sent to FDA?
Event Location No Information
Date Manufacturer Received08/04/2014
Was Device Evaluated by Manufacturer? Device Not Returned to Manufacturer
Is the Device Single Use? Yes
Is This a Reprocessed and Reused Single-Use Device?
Type of Device Usage Initial

Patient Treatment Data
Date Received: 09/02/2014 Patient Sequence Number: 1