BEUDAMED
    FDA Adverse Event Injury Summary report: N

    LAP BAND PORT

    MDR report key: 1962609 · Received January 12, 2011

    Report

    Report Number
    MW5018986
    Event Type
    Injury
    Date Received
    January 12, 2011
    Date of Event
    December 23, 2010
    Report Date
    December 23, 2010
    Manufacturer
    ALLERGAN
    Product Code
    LTI
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    AL, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    LAP BAND PORT TUBING APPEARED SEVERED. ERROR PRIOR TO EXPLORATION OF PORT SITE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 LAP BAND PORT LAP BAND PORT LTI ALLERGAN MA4101

    Patients

    Seq Age Sex Outcome Treatment
    1 25 YR Hospitalization