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

Catalog Number	TRF-450
Medical Device Problem Code	Patient-Device Incompatibility (2682)
Health Effect - Clinical Codes	Capsular Contracture (1761); Swollen Lymph Nodes (2093)
Date of Event	10/26/2015
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.In response to fda report number mw5088447.Further information from the reporter regarding event, product, or patient details has been requested.No additional information is available at this time.The events of capsular contracture and lymphadenopathy are physiological complications and analysis of the device generally does not assist allergan in determining a probable cause for these events.The reason for reoperation was capsular contracture baker grade unknown and lymphadenopathy.
Event or Problem Description
Patient reported via regulatory agency "grade 4 capsular contracture, pain," and "enlarged lymph nodes throughout my chest and abdomen to my pelvis." patient additionally reported "issues with my arms, skin, rashes and range of motion, chronic fatigue, inflammation arthritis or rheumatoid arthritis, joint pain, my eyes and vision have changed, get sick easily, memory and focus issues, cannot keep up, and lost some hair in patches;" these events are not device related.The device was explanted.This record is for the left side.

• 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; CS
• MDR Report Key: 9554142
• Report Number: 9617229-2019-23613
• Device Sequence Number: 1763435
• Product Code: FTR
• UDI-Device Identifier: 10888628008342
• UDI-Public: 10888628008342
• Combination Product (Y/N): N
• PMA/510(K) Number: P020056
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2015
• Device Explanted Year: 2016
• Reporter Type: Manufacturer
• Report Source: consumer,other
• Initial Reporter Occupation: Other
• Type of Report: Initial

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 Catalogue Number: TRF-450
• Was Device Available for Evaluation?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 08/16/2019
• Initial Report FDA Received Date: 01/06/2020
• 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