BEUDAMED
    FDA Adverse Event Injury Summary report: N

    AVAULTA BIOSYNTHETIC SUPPORT SYSTEM

    MDR report key: 2822823 · Received August 5, 2009

    Report

    Report Number
    1018233-2009-00092
    Event Type
    Injury
    Date Received
    August 5, 2009
    Report Date
    August 5, 2009
    Manufacturer
    SOFRADIM PRODUCTION
    Product Code
    FTL
    Adverse Event
    Yes
    Report Source
    Distributor report
    Reporter Location
    WV, US
    Reporter Occupation
    ATTORNEY

    Narratives

    Description of Event or Problem · 1

    IT WAS ALLEGED BY THE PT'S ATTORNEY FOLLOWING AN ANTERIOR REPAIR AND A POSTERIOR REPAIR PERFORMED IN 2007, "THE PT EXPERIENCED MENTAL AND PHYSICAL PAIN AND SUFFERING, PERMANENT INJURY, PHYSICAL DEFORMITY, LOSS OF A BODILY ORGAN SYSTEM AND HAS UNDERGONE OR WILL UNDERGO CORRECTIVE SURGERY OR SURGERIES". THE PT'S ATTORNEY PROVIDED THE PT'S IMPLANT CARD. THE DIAGNOSIS AND TYPE OF TREATMENT FOR THIS SPECIFIC PT IS NOT KNOWN.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 AVAULTA BIOSYNTHETIC SUPPORT SYSTEM FTL FTL SOFRADIM PRODUCTION NA ZGK00107

    Patients

    Seq Age Sex Outcome Treatment
    1 53 YR Required Intervention