BEUDAMED
    FDA Adverse Event Injury Summary report: N

    MESH - COMPOSIX

    MDR report key: 1982243 · Received January 25, 2011

    Report

    Report Number
    1213643-2011-00023
    Event Type
    Injury
    Date Received
    January 25, 2011
    Report Date
    January 6, 2011
    Manufacturer
    DAVOL INC., SUB. C.R. BARD, INC.
    Product Code
    FTL
    PMA / PMN Number
    K971745
    Removal / Correction Number
    NA
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    MN, US
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 1

    WE HAVE CONTACTED THE INITIAL REPORTER TO REQUEST ADDITIONAL INFO AND TO REQUEST RETURN OF THE DEVICE FOR EVAL. THIS MDR INCLUDES ALL PT, EVENT AND DEVICE INFO DAVOL HAS RECEIVED TO DATE. CURRENTLY, IT IS UNK WHETHER OR NOT THE DEVICE MAY HAVE CAUSED OR CONTRIBUTED TO THE EVENT AS NO PRODUCT HAS BEEN RETURNED NOR HAS A SPECIFIC PRODUCT PROBLEM BEEN REPORTED. NO CONCLUSION CAN BE DRAWN AT THIS TIME. SEE MDR 1213643-2011-00024 FOR INFO RELATED TO THE BARD COMPOSIX L/P MESH IMPLANTED IN PT.

    Description of Event or Problem · 1

    ATTORNEY REPORTED: PT HAD A BARD COMPOSIX MESH AND A BARD COMPOSIX L/P MESH IMPLANTED. AS A RESULT OF HAVING THE PATCHES IMPLANTED IN PT, PT SUFFERED DISABLING PAIN AND REQUIRED SURGICAL INTERVENTION. PT SUFFERED AND WILL CONTINUE TO SUFFER INJURY, DISABILITY.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 MESH - COMPOSIX FTL DAVOL INC., SUB. C.R. BARD, INC. NA NI

    Patients

    Seq Age Sex Outcome Treatment
    1 Required Intervention