MAUDE Adverse Event Report: COLOPLAST A/S UNKNOWN FEM PELVIC HEALTH MESH; SURIGAL MESH

Device Problem Insufficient Information (3190)

Patient Problems Unspecified Infection (1930); Abnormal Vaginal Discharge (2123); Blood Loss (2597)

Event Date 10/17/2005

Event Type  Injury  

Manufacturer Narrative

Coloplast has not been provided any corroborating evidence to verify the information contained in this report.

Event Description

As reported to coloplast, though not verified, the patient's legal representative stated vaginal discharge, infection, bleeding, and exposure.The product information for the implanted device was not available at the time of the complaint.

• Brand Name: UNKNOWN FEM PELVIC HEALTH MESH
• Type of Device: SURIGAL MESH
• Manufacturer (Section D): COLOPLAST A/S; holtedam 1; humlebaek, DK-30 50; DA DK-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: 5936689
• MDR Text Key: 54211833
• Report Number: 2125050-2016-00207
• Device Sequence Number: 1
• Product Code: FTL
• 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: 09/08/2016

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 09/08/2016
• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: No
• Device Operator: Physician
• Was Device Available for Evaluation?: No
• Date Manufacturer Received: 08/29/2016
• 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
• Patient Age: 57 YR