BEUDAMED
    FDA Adverse Event Injury Summary report: N

    PARIETEX UGYTEX PP ANTERIOR KIT X1

    MDR report key: 2901083 · Received October 31, 2012

    Report

    Report Number
    9615742-2012-00555
    Event Type
    Injury
    Date Received
    October 31, 2012
    Date of Event
    July 21, 2006
    Report Date
    October 4, 2012
    Manufacturer
    SOFRADIM PRODUCTION
    Product Code
    FTL
    PMA / PMN Number
    K051503
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    GA, US
    Reporter Occupation
    OTHER
    Health Professional
    N

    Narratives

    Additional Manufacturer Narrative · 1

    (B)(4). NOTE: THIS REPORT CORRESPONDS WITH BARD'S REPORT #409699 FOR AN "AVAULTA ANTERIOR." ADDITIONAL INFORMATION FROM THE IMPORTER REPORT: (B)(6) 2012, AVAULTA ANTERIOR BIOSYNTHETIC SUPPORT SYSTEM, CATALOG # 486010,(B)(6). ATTORNEY.

    Description of Event or Problem · 1

    PROCEDURE: UROLOGICAL/GYNECOLOGICAL. ACCORDING TO THE REPORTER: THE PATIENT UNDERWENT A REPAIR PROCEDURE AND THE PATIENT ALLEGEDLY EXPERIENCED PAIN AND INJURY. PATIENT HAS UNDERGONE OR WILL UNDERGO CORRECTIVE SURGERY OR SURGERIES. THE PATIENT'S ATTORNEY ALLEGED A DEFICIENCY AGAINST THE DEVICE. ADDITIONAL INFORMATION HAS BEEN REQUESTED, BUT NOT YET RECEIVED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 PARIETEX UGYTEX PP ANTERIOR KIT X1 AVAULTA ANTERIOR SYSTEM FTL SOFRADIM PRODUCTION NA ZGC00002

    Patients

    Seq Age Sex Outcome Treatment
    1 47 YR Female Required Intervention| O URETEX TO2 URETHRAL SUPPORT SYSTEM| URETEX TO2 URETHRAL SUPPORT SYSTEM