BEUDAMED
    FDA Adverse Event Injury Summary report: N

    LAP BAND AP SYSTEM

    MDR report key: 2171312 · Received July 16, 2011

    Report

    Report Number
    MW5021402
    Event Type
    Injury
    Date Received
    July 16, 2011
    Date of Event
    July 7, 2011
    Report Date
    July 16, 2011
    Manufacturer
    ALLERGAN, INC.
    Product Code
    LTI
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    NC, US
    Reporter Occupation
    PATIENT

    Narratives

    Description of Event or Problem · 1

    I HAD AN AP LAP BAND, MFG BY ALLERGAN, PLACED ON (B)(6) 2008. FROM THE BEGINNING, I HAD DIFFICULTY SWALLOWING ALTHOUGH I TOOK PEA-SIZED BITES & CHEWED EVERYTHING TO MUSH. DENSE PROTEIN AND VEGETABLES, IN VEGETABLES, WERE VERY DIFFICULT FOR ME TO SWALLOW. I SUFFERED CHEST PAIN, VOMITING, AND EXCESSIVE SALIVA PRODUCTION AS A RESULT. DATES OF USE: (B)(6) 2008 - (B)(6) 2011. EVENT ABATED AFTER USE : YES.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 LAP BAND AP SYSTEM NONE LTI ALLERGAN, INC.

    Patients

    Seq Age Sex Outcome Treatment
    1 40 YR Other