BEUDAMED
    FDA Adverse Event Injury Summary report: N

    LAP-BAND ACCESS PORT KIT (UNK SIZE)

    MDR report key: 2166974 · Received July 13, 2011

    Report

    Report Number
    2024601-2011-00551
    Event Type
    Injury
    Date Received
    July 13, 2011
    Date of Event
    December 18, 2010
    Report Date
    June 16, 2011
    Manufacturer
    ALLERGAN
    Product Code
    LTI
    PMA / PMN Number
    P000008
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    MI, US
    Reporter Occupation
    PHYSICIAN
    Health Professional
    Yes

    Narratives

    Additional Manufacturer Narrative · 0

    MEDWATCH SENT TO FDA ON. 08/23/2011.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    120364 LAP-BAND ACCESS PORT KIT (UNK SIZE) LTI ALLERGAN NI

    Patients

    Seq Age Sex Outcome Treatment
    1 38 YR Female Required Intervention