BEUDAMED
    FDA Adverse Event Injury Summary report: N

    BREAST IMPLANTS

    MDR report key: 2140645 · Received June 22, 2011

    Report

    Report Number
    MW5021116
    Event Type
    Injury
    Date Received
    June 22, 2011
    Date of Event
    January 13, 2011
    Report Date
    June 13, 2011
    Product Code
    FWM
    Adverse Event
    Yes
    Report Source
    Voluntary report
    Reporter Location
    TN, US
    Reporter Occupation
    PHYSICIAN

    Narratives

    Description of Event or Problem · 1

    ALK NEGATIVE ALCL - ANAPLASTIC LARGE CELL LYMPHOMA. POSSIBLY RELATED TO BREAST IMPLANTS. HX OF HL - TREATED WITH MANTLE FIELD RADIATION THERAPY AND BREAST CANCER TREATED WITH SURGERY, CHEMO AND TAMOXIFEN.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 BREAST IMPLANTS BREAST IMPLANTS FWM

    Patients

    Seq Age Sex Outcome Treatment
    1 57 YR Other