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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: TISSUE SCIENCE LABORATORIES MESH TSL - PELVICOL¿ MESH, SURGICAL, POLYMERIC

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TISSUE SCIENCE LABORATORIES MESH TSL - PELVICOL¿ MESH, SURGICAL, POLYMERIC Back to Search Results
Model Number 482047
Device Problems Material Perforation (2205); Adverse Event Without Identified Device or Use Problem (2993)
Patient Problems Perforation (2001); Injury (2348)
Event Type  Injury  
Manufacturer Narrative

Alternative summary report for exemption e2013038. Procode: ftl. Reporting period: march 1, 2019 through april 30, 2019. Total number of events: 4 (2 new event reports, 2 supplemental event reports). Total events per brand name: pelvicol (3 events), ugytex (1 events). New events per brand name: pelvicol (2 events). If information is provided in the future, a supplemental report will be issued.

 
Event Description

Asr exemption e2013038. The patient¿s attorney alleged a deficiency against the device. The product was used for therapeutic treatment of recurrent pelvic relaxation. It was reported that after implant, the patient experienced an intraoperative perforation of the left external iliac requiring 3 sutures through the area of the vein.

 
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Brand NameMESH TSL - PELVICOL¿
Type of DeviceMESH, SURGICAL, POLYMERIC
Manufacturer (Section D)
TISSUE SCIENCE LABORATORIES
victoria house, victoria road
aldershot, hampshire GU11 1EJ
GB GU11 1EJ
Manufacturer (Section G)
TISSUE SCIENCE LABORATORIES
victoria house, victoria road
aldershot, hampshire GU11 1EJ
GB GU11 1EJ
Manufacturer Contact
lisa hernandez
60 middletown ave
north haven, CT 06473
2034925563
MDR Report Key8642112
MDR Text Key146117651
Report Number9617613-2019-00066
Device Sequence Number1
Product Code FTL
Combination Product (Y/N)N
Reporter Country CodeUS
PMA/PMN NumberK992556
Number of Events Reported1
Summary Report (Y/N)N
Report Source Manufacturer
Source Type CONSUMER
Reporter Occupation
Type of Report Initial
Report Date 05/24/2019
1 Device Was Involved in the Event
1 Patient Was Involved in the Event
Date FDA Received05/24/2019
Is This An Adverse Event Report? Yes
Is This A Product Problem Report? Yes
Device Operator HEALTH PROFESSIONAL
Device EXPIRATION Date10/29/2005
Device MODEL Number482047
Device Catalogue Number482047
Device LOT Number03B14
Was Device Available For Evaluation? No
Is The Reporter A Health Professional?
Was the Report Sent to FDA?
Event Location No Information
Date Manufacturer Received03/27/2019
Was Device Evaluated By Manufacturer? No Answer Provided
Is The Device Single Use? Yes
Is this a Reprocessed and Reused Single-Use Device? No
Type of Device Usage Initial

Patient TREATMENT DATA
Date Received: 05/24/2019 Patient Sequence Number: 1
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