BEUDAMED
    FDA Adverse Event Injury Summary report: N

    DESARA

    MDR report key: 2914867 · Received January 8, 2013

    Report

    Report Number
    3003990090-2012-00107
    Event Type
    Injury
    Date Received
    January 8, 2013
    Date of Event
    August 12, 2009
    Report Date
    December 21, 2012
    Manufacturer
    CALDERA MEDICAL, INC.
    Product Code
    FTL
    PMA / PMN Number
    K072456
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    MO, US
    Reporter Occupation
    NOT APPLICABLE

    Narratives

    Description of Event or Problem · 1

    EVENT WAS REPORTED TO CALDERA MEDICAL BY AN ATTORNEY. LEGAL COMPLAINT STATES THAT PATIENT SUFFERED BODILY INJURIES. INJURIES AND OR SYMPTOMS INCLUDE ABDOMINAL PAIN AND PAIN DURING INTERCOURSE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    10465 DESARA SURGICAL MESH FTL CALDERA MEDICAL, INC. CAL-DS01 30003

    Patients

    Seq Age Sex Outcome Treatment
    1 Other