MAUDE Adverse Event Report: AMERICAN MEDICAL SYSTEMS AMS MINIARC PRECISE SINGLE-INCISION SLING; MESH, SURGICAL, POLYMERIC

Catalog Number 720191-01

Device Problem Insufficient Information (3190)

Patient Problem Injury (2348)

Event Type  Injury  

Manufacturer Narrative

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Event Description

It was reported by the plaintiff's attorney that the plaintiff experienced an unspecified injury.The device remains implanted.No further complications have been reported in relation to this event.

• Brand Name: AMS MINIARC PRECISE SINGLE-INCISION SLING
• Type of Device: MESH, SURGICAL, POLYMERIC
• Manufacturer (Section D): AMERICAN MEDICAL SYSTEMS; 10700 bren road w; minnetonka MN 55343
• Manufacturer (Section G): AMERICAN MEDICAL SYSTEMS; 10700 bren road w; minnetonka MN 55343
• Manufacturer Contact: erika merrick ; 10700 bren road w; minnetonka, MN 55343 ; 8442511068
• MDR Report Key: 5324796
• MDR Text Key: 34287635
• Report Number: 2183959-2015-63081
• Device Sequence Number: 1
• Product Code: PAH
• Combination Product (y/n): N
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: consumer,other
• Type of Report: Initial
• Report Date: 10/13/2015

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: No
• Device Operator: Attorney
• Device Expiration Date: 12/11/2015
• Device Catalogue Number: 720191-01
• Was Device Available for Evaluation?: No
• Initial Date Manufacturer Received: 10/13/2015
• Initial Date FDA Received: 12/23/2015
• Was Device Evaluated by Manufacturer?: Device Not Returned to Manufacturer
• Date Device Manufactured: 01/01/2013
• 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): Disability
• Patient Weight: 96