FDA Adverse Event
Injury
Summary report: N
PARIETEX UGYTEX PP POSTERIOR KIT X1
MDR report key: 3131343
·
Received May 17, 2013
Report
- Report Number
- 9615742-2013-00427
- Event Type
- Injury
- Date Received
- May 17, 2013
- Date of Event
- August 10, 2006
- Report Date
- May 8, 2018
- Manufacturer
- SOFRADIM PRODUCTION
- Product Code
- OTP
- 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).
Description of Event or Problem · 1
PROCEDURE TYPE: UROGYNECOLOGICAL. ACCORDING TO THE REPORTER: THE PT'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 |
|---|---|---|---|---|---|---|---|
| 220058 | PARIETEX UGYTEX PP POSTERIOR KIT X1 | AVAULTA POSTERIOR SYSTEM | OTP | SOFRADIM PRODUCTION | ZGE00582 |
Patients
| Seq | Age | Sex | Outcome | Treatment |
|---|---|---|---|---|
| 1 | 39 YR | Female | Other | UGYKA PARIETEX UGYTEX PP ANTERIOR KIT X1: ZGC00156, EXP: 03/31/2011, MFR: 03/2006| PARIETEX UGYTEX PP ANTERIOR KIT X1: (B)(4)| EXP: 03/31/2011, MFR: 03/2006| UGYKA |