BEUDAMED
    FDA Adverse Event Other Summary report: N

    ALLERGAN

    MDR report key: 1061862 · Received June 16, 2008

    Report

    Report Number
    MW5007333
    Event Type
    Other
    Date Received
    June 16, 2008
    Date of Event
    June 9, 2008
    Report Date
    June 16, 2008
    Manufacturer
    ALLERGAN, INC.
    Product Code
    LCJ
    Report Source
    Voluntary report
    Reporter Location
    VA, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    ON 5/2, RIGHT MASTECTOMY WITH SENITRAL LYMPH NODE BIOPSY AND AXILLARY DISSECTION. IMMEDIATE RECONSTRUCTION WITH TISSUE EXPANDER. 0N 6/4, PT HAD OUTPATIENT PROCEDURE TO REMOVE TISSUE EXPANDER.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ALLERGAN TISSUE EXPANDER - BREAST LCJ ALLERGAN, INC.

    Patients

    Seq Age Sex Outcome Treatment
    1 64 YR