BEUDAMED
    FDA Adverse Event Injury Summary report: N

    PELVICOL 6 X 8 CM

    MDR report key: 3131043 · Received May 21, 2013

    Report

    Report Number
    9617613-2013-00278
    Event Type
    Injury
    Date Received
    May 21, 2013
    Date of Event
    June 29, 2004
    Report Date
    April 26, 2013
    Manufacturer
    COVIDIEN, FORMERLY TISSUE SCIENCE
    Product Code
    FTL
    PMA / PMN Number
    K992556
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    GA, US
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 1

    (B)(4).

    Description of Event or Problem · 1

    PROCEDURE TYPE: UROGYNECOLOGICAL. ACCORDING TO THE REPORTER: THE PATIENT'S ATTORNEY ALLEGED A DEFICIENCY AGAINST THE DEVICE. PRODUCT WAS USED FOR THERAPEUTIC TREATMENT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    225145 PELVICOL 6 X 8 CM PELVICOL MESH FTL COVIDIEN, FORMERLY TISSUE SCIENCE 04B04-2

    Patients

    Seq Age Sex Outcome Treatment
    1 53 YR Other URETEX SUPPORT PP KIT X1, ITEM #URETEXSUP,| LOT #C24054SUP, EXPIRATION 02/28/2009