BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    ALLERGAN

    MDR report key: 2061351 · Received April 13, 2011

    Report

    Report Number
    MW5020274
    Event Type
    Malfunction
    Date Received
    April 13, 2011
    Date of Event
    March 29, 2011
    Report Date
    April 7, 2011
    Manufacturer
    ALLERGAN
    Product Code
    LTI
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    IL, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    LAP BAND EXPLANTED ON (B)(6) 2011 FOR WEAR AND TEAR. NO HARM TO PT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ALLERGAN LABG 10.0CM ADJUSTABLE GASTRIC BANDING SYSTEM LTI ALLERGAN

    Patients

    Seq Age Sex Outcome Treatment
    1 58 YR