FDA Adverse Event
Injury
Summary report: N
SEE H10
MDR report key: 2940554
·
Received January 30, 2013
Report
- Report Number
- 2183959-2013-00520
- Event Type
- Injury
- Date Received
- January 30, 2013
- Report Date
- December 17, 2012
- Manufacturer
- AMERICAN MEDICAL SYSTEMS, INC.
- Product Code
- FTL
- Adverse Event
- Yes
- Product Problem
- Yes
- Report Source
- Manufacturer report
- Reporter Location
- SC, US
- Reporter Occupation
- NOT APPLICABLE
Narratives
Additional Manufacturer Narrative · 1
IT IS UNK WHICH PELVIC MESH PRODUCT WAS IMPLANTED IN 2002. SHOULD ADDITIONAL INFO BECOME AVAILABLE REGARDING THIS EVENT IT WILL BE RE-EVALUATED AND A FOLLOW-UP REPORT WILL BE SENT AS APPROPRIATE. LAWYER-FILED REPORT - (B)(4).
Description of Event or Problem · 1
IT WAS REPORTED BY THE PLAINTIFF'S ATTORNEY THAT THE PLAINTIFF EXPERIENCED EMOTIONAL DISTRESS AND A PROBLEM WITH THE PRODUCT. RELATED: TO MFR REPORT # 2183959-2013-00519. RELATED: TO MFR REPORT # 2183959-2013-00518.
Devices
| Seq | Brand | Generic | Product Code | Manufacturer | Model | Lot | UDI-DI |
|---|---|---|---|---|---|---|---|
| 41711 | SEE H10 | SURGICAL MESH | FTL | AMERICAN MEDICAL SYSTEMS, INC. |
Patients
| Seq | Age | Sex | Outcome | Treatment |
|---|---|---|---|---|
| 1 | Disability | APOGEE SYSTEM| PERIGEE SYSTEM | TVT-SECUR| TVT-SECUR| PERIGEE SYSTEM| APOGEE SYSTEM |