FDA Adverse Event
Malfunction
Summary report: N
LAP-BAND ADJUSTABLE GASTRIC BANDING SYSTEM VG
MDR report key: 1203373
·
Received October 14, 2008
Report
- Report Number
- 2024601-2008-00790
- Event Type
- Malfunction
- Date Received
- October 14, 2008
- Date of Event
- August 1, 2008
- Report Date
- September 18, 2008
- Manufacturer
- COSTA RICA
- Product Code
- LTI
- PMA / PMN Number
- P000008
- Product Problem
- Yes
- Report Source
- Manufacturer report
- Reporter Location
- TX, US
- Reporter Occupation
- OTHER
Narratives
Additional Manufacturer Narrative · 1
TAPER II. VISUAL EXAMINATION OF THE RETURNED DEVICE DETERMINED THE ACCESS PORT TUBING CONNECTOR TO BE A TAPER II. ALLERGAN HAS RECEIVED THE PRODUCE; HOWEVER, THE ANALYSIS RESULTS ARE PENDING AT THIS TIME. DEVICE LABELING ADDRESSES THE POSSIBLE OUTCOME OF LEAKAGE AS FOLLOWS: "DEFLATION OF THE BAND MAY OCCUR DUE TO LEAKAGE FROM THE BAND, THE PORT OR THE CONNECTOR TUBING".
Description of Event or Problem · 1
REPORTED BY DOCTOR'S OFFICE AS: "A PORT LEAK WITH PORT REVISION."
Devices
| Seq | Brand | Generic | Product Code | Manufacturer | Model | Lot | UDI-DI |
|---|---|---|---|---|---|---|---|
| 1 | LAP-BAND ADJUSTABLE GASTRIC BANDING SYSTEM VG | DEVICE FOR TREATMENT OF MORBID OBESITY | LTI | COSTA RICA | NA | NI |
Patients
| Seq | Age | Sex | Outcome | Treatment |
|---|---|---|---|---|
| 1 | 41 YR |