MAUDE Adverse Event Report: COLOPLAST A/S OMNISURE; SURGICAL MESH

Model Number 5166001400

Device Problem Appropriate Term/Code Not Available (3191)

Patient Problems Micturition Urgency (1871); Pain (1994); Dyspareunia (4505); Urinary Incontinence (4572)

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 or conclusions contained in the original mdr or in any prior supplemental reports, a follow-up report will be submitted.

Event Description

As reported to coloplast, though not verified, the patient with this device experienced continued transverse defect.A small separation at fourchette area was observed.Additionally, it was noted that vaginal mesh exposure, chronic pelvic pain, recurrent stress urinary incontinence proven on urodynamic testing, superficial dyspareunia secondary to her over-corrected perineum, abnormal urinary stream which was also thought to be in part due to the patient's previous sling placement, post void dribbling, and vaginal discharge.Recurrent cystocele, rectocele and enterocele.

• Brand Name: OMNISURE
• Type of Device: SURGICAL MESH
• Manufacturer (Section D): COLOPLAST A/S; holtedam 1; humlebæk 3050 ; DA 3050
• Manufacturer (Section G): COLOPLAST MANUFACTURING US, LLC; 1601 west river road north; minneapolis MN 55411
• Manufacturer Contact: usaby angela kilian ; 1601 west river road north; minneapolis, MN 55411 ; 8007880293
• MDR Report Key: 12214673
• MDR Text Key: 263098966
• Report Number: 2125050-2021-00959
• Device Sequence Number: 1
• Product Code: FTL
• Combination Product (y/n): N
• PMA/PMN Number: K092203
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: consumer
• Reporter Occupation: Non-Healthcare Professional
• Type of Report: Initial
• Report Date: 07/22/2021

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 07/22/2021
• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: Yes
• Device Operator: Health Professional
• Device Model Number: 5166001400
• Device Catalogue Number: 516600
• Was Device Available for Evaluation?: No
• Date Manufacturer Received: 06/24/2021
• 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): Hospitalization; Required Intervention