MAUDE Adverse Event Report: ALLERGAN (COSTA RICA) INSPIRA TEXTURED SILICONE GEL FILLED BREAST IMPLANT; PROSTHESIS, BREAST, NONINFLATABLE, INTERNAL, SILICONE GEL-FILLED

Model Number	TRL-380
Medical Device Problem Code	Material Rupture (1546)
Health Effect - Clinical Code	Failure of Implant (1924)
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
Allergan did not submit this mdr within 30 days of becoming aware.Recent stimulated reporting related to 2011068-7/2/19-001-r has increased complaint and mdr volume.Allergan is implementing a plan to address the increased volumes.Information contained in this report was previously submitted through psr on 22/jan/2019.(b)(6).A review of the device history record has been completed.No deviations or non-conformances noted.Device evaluation: "the device related to the reported events of capsular contracture and crease/folding of implant, was received on mar 04, 2021 with lot number 2857552.Visual analysis of the returned device identified: underweight, fold creases, and an opening on posterior.A microscopic analysis was performed which identified: a sharp opening on posterior and wear abrasion.A dimension measurement in the shell was performed which identified the thickness within specification.Based on the device analysis the final assessment is: a sharp opening on posterior assessed as unidentified (tear) opening.Creases are observed but have no relationship with manufacturing." further information from the reporter regarding event, product, or patient details has been requested.No additional information is available at this time.Reason for reoperation: "capsular contracture, baker grade ii".
Event or Problem Description
Healthcare professional reported a left side capsular contracture, baker grade ii.Healthcare professional later reported "rupture," "double capsule" and "any creases." device has been explanted.

• Brand Name: INSPIRA TEXTURED SILICONE GEL FILLED BREAST IMPLANT
• Common Device Name: PROSTHESIS, BREAST, NONINFLATABLE, INTERNAL, SILICONE GEL-FILLED
• Manufacturer (Section D): ALLERGAN (COSTA RICA); 900 parkway global park; zona franca
• MDR Report Key: 11793736
• Report Number: 9617229-2021-07084
• Device Sequence Number: 3962044
• Product Code: FTR
• UDI-Device Identifier: 10888628007741
• UDI-Public: 10888628007741
• Combination Product (Y/N): N
• Initial Reporter State: MO
• Initial Reporter Country: US
• PMA/510(K) Number: P020056
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2016
• Device Explanted Year: 2021
• Reporter Type: Manufacturer
• Report Source: health professional
• Initial Reporter Occupation: Physician
• Type of Report: Initial
• Report Date (Section B): 05/07/2021

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
• Operator of Device: Health Professional
• Device Expiration Date: 12/23/2020
• Device Model Number: TRL-380
• Device Catalogue Number: TRL-380
• Device Lot Number: 2857552
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 03/04/2021
• Type of Report(Section G): Initial
• Initial Date Received by Manufacturer: 02/22/2021
• Initial Report FDA Received Date: 05/07/2021
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1
• Outcome Attributed to Adverse Event: Required Intervention