BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    MENTOR BREAST IMPLANT

    MDR report key: 2831948 · Received November 7, 2012

    Report

    Report Number
    MW5027584
    Event Type
    Malfunction
    Date Received
    November 7, 2012
    Date of Event
    October 30, 2012
    Report Date
    November 7, 2012
    Manufacturer
    MENTOR
    Product Code
    FWM
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    MO, US
    Reporter Occupation
    OTHER HEALTH CARE PROFESSIONAL

    Narratives

    Description of Event or Problem · 1

    DEFLATION OF SALINE BREAST IMPLANT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 MENTOR BREAST IMPLANT SALINE BREAST IMPLANT FWM MENTOR 5545412

    Patients

    Seq Age Sex Outcome Treatment
    1 55 YR