MAUDE Adverse Event Report: ALLERGAN (COSTA RICA) STYLE 410 COHESIVE SILICONE GEL FILLED BREAST IMPLANT; PROSTHESIS, BREAST, NONINFLATABLE, INTERNAL, SILICONE GEL-FILLED

Model Number	FX-410410
Medical Device Problem Code	Device Appears to Trigger Rejection (1524)
Health Effect - Clinical Codes	Capsular Contracture (1761); Seroma (2069)
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
Further information from the reporter regarding event, product, or patient details has been requested.No additional information is available at this time.A review of the device history record has been completed.No deviations or non-conformances noted.Device evaluation: deformation device, creases fold, brown particles, voids, wear abrasion and weight to the spec.Bubbles in the gel observed after autoclave cycle.Base on the device analysis the final assessment is: no issues found related with the manufacturing process.The reported events are physiological complications and analysis of the device generally does not assist allergan in determining a probable cause for these events.Reason for reoperation: "right side capsular contracture baker grade unknown" and "left implant is hard on one side.".
Event or Problem Description
Patient reported left side is "hard", pain, swelling.Healthcare professional reported a bilateral removal of textured breast implants due to the patient concern with the product.Patient representative reported "fear of alcl, to reduce risk of alcl, and due to symptoms consistent with alcl and fear of alcl including: mental anguish, increased risk of alcl, evaluation for alcl, explant, reconstruction, seromas, physical pain, chronic gastrointestinal upset or reflux, significant weight loss, capsular contracture, itching, swelling, hardening of breasts, scarring and disfigurement.Additionally, plaintiff suffered aggravation of underlying conditions including emotional distress and anxiety, as well as loss of quality of life; and other physical and emotional manifestations that are severe and ongoing." device has been explanted.

• Brand Name: STYLE 410 COHESIVE 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: 11933028
• Report Number: 9617229-2021-46226
• Device Sequence Number: 11857377
• Product Code: FTR
• UDI-Device Identifier: 10888628002982
• UDI-Public: 10888628002982
• Combination Product (Y/N): N
• Initial Reporter State: FL
• Initial Reporter Country: US
• PMA/510(K) Number: P040046
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2016
• Device Explanted Year: 2019
• Reporter Type: Manufacturer
• Report Source: consumer,health professional
• Initial Reporter Occupation: Other
• Type of Report: Initial
• Report Date (Section B): 06/03/2021

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: 02/15/2021
• Device Model Number: FX-410410
• Device Catalogue Number: FX-410410
• Device Lot Number: 2885073
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 11/13/2019
• Type of Report(Section G): Initial
• Initial Date Received by Manufacturer: 05/05/2021
• Initial Report FDA Received Date: 06/03/2021
• 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