MAUDE Adverse Event Report: COLOPLAST A/S ARIS TRANS-OBTURATOR; SURGICAL MESH

Model Number UR31011002

Device Problem Extrusion (2934)

Patient Problem Hematuria (2558)

Event Date 11/24/2016

Event Type  Injury  

Manufacturer Narrative

Without the benefit of examination and testing, coloplast is precluded from commenting on the condition of the device or the cause of the occurrence.Should additional facts prompt us to alter or supplement any information of conclusions contained in the original mdr or in any prior supplemental reports, a follow-up report will be submitted.

Event Description

According to the available information patient admitted to hospital as emergency.Noted to have hematuria.Tape extrusion noted on vaginal examination.Old notes obtained and case discussed at pelvic floor meeting.Vaginal extrusion of mid urethral synthetic sling for stress incontinence.Patient listed for revision surgery.

• Brand Name: ARIS TRANS-OBTURATOR
• Type of Device: SURGICAL MESH
• Manufacturer (Section D): COLOPLAST A/S; holtedam 1; humlebaek, da 3050 ; DA 3050
• Manufacturer (Section G): COLOPLAST MANUFACTURING US, LLC; 1601 west river road north; minneapolis MN 55411
• Manufacturer Contact: christine buckvold ; 1601 west river road north; minneapolis, MN 55411 ; 6123024982
• MDR Report Key: 6171206
• MDR Text Key: 62283018
• Report Number: 2125050-2016-00377
• Device Sequence Number: 1
• Product Code: OTN
• Combination Product (y/n): N
• PMA/PMN Number: K050148
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: foreign,health professional
• Type of Report: Initial
• Report Date: 12/13/2016

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: Physician
• Device Model Number: UR31011002
• Device Catalogue Number: UR31011002
• Was Device Available for Evaluation?: No
• Initial Date Manufacturer Received: 12/07/2016
• Initial Date FDA Received: 12/13/2016
• 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?: No
• Type of Device Usage: N
• Patient Sequence Number: 1
• Patient Outcome(s): Other