FDA Adverse Event Other Summary report: N

MEDPOR IMPLANT

MDR report key: 1413817 · Received July 8, 2009

Report

Report Number
1057129-2009-00005
Event Type
Other
Date Received
July 8, 2009
Date of Event
March 13, 2009
Report Date
July 8, 2009
Manufacturer
POREX SURGICAL
Product Code
HPZ
Adverse Event
Yes
Report Source
Manufacturer report
Reporter Location
FL, US
Reporter Occupation
OTHER

Narratives

Additional Manufacturer Narrative · 1

FOLLOWING A REVIEW OF THE DEVICE HISTORY RECORD FOR LOT NUMBER 80014-D232M11, IT WAS DETERMINED THAT ALL PROCESSES AND TEST CRITERIA ARE WITHIN THE MEDPOR IMPLANT FINISHED PRODUCT SPEC.

Description of Event or Problem · 1

THE DOCTOR STATED THAT THE PT RECEIVED A MEDPOR SST SPHERE IMPLANT IN (B)(6) 2009. THE DOCTOR STATED THAT AT APPROX FOUR WEEK POST OP, DURING A FOLLOW-UP EXAM, IT WAS NOTICED THAT THE IMPLANT HAD EXPOSED. THE DOCTOR REPORTED THAT IN (B)(6) 2009, THE MEDPOR IMPLANT WAS NOT REMOVED AND THE EXPOSURE OF THE IMPLANT WAS PATCHED USING (B)(4).

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1 MEDPOR IMPLANT FACIAL RECONSTRUCTION HPZ POREX SURGICAL NA D232M11

Patients

Seq Age Sex Outcome Treatment
1 65 YR Other