BEUDAMED
    FDA Adverse Event Injury Summary report: N

    PELVICOL ACELLULAR COLLAGEN MATRIX

    MDR report key: 3142348 · Received May 17, 2013

    Report

    Report Number
    1018233-2013-02058
    Event Type
    Injury
    Date Received
    May 17, 2013
    Report Date
    April 18, 2013
    Manufacturer
    TISSUE SCIENCE LABORATORIES
    Product Code
    FTL
    Adverse Event
    Yes
    Report Source
    Distributor report
    Reporter Location
    MO, US
    Reporter Occupation
    ATTORNEY

    Narratives

    Description of Event or Problem · 1

    THE PT'S ATTORNEY ALLEGED A DEFICIENCY AGAINST THE DEVICE. ADDITIONAL INFO HAS BEEN REQUESTED, BUT NOT YET RECEIVED. COMPLAINT # (B)(4).

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    219872 PELVICOL ACELLULAR COLLAGEN MATRIX FTL TISSUE SCIENCE LABORATORIES NA 02A14

    Patients

    Seq Age Sex Outcome Treatment
    1 40 YR Required Intervention SUTURE| IN-FAST ULTRA| IN-FAST ULTRA SWIVAL SCEW WITH 38CM POLYPROPYLENE