BEUDAMED
    FDA Adverse Event Injury Summary report: N

    PELVICOL 4 X 12 CM

    MDR report key: 3143113 · Received May 24, 2013

    Report

    Report Number
    9617613-2013-00303
    Event Type
    Injury
    Date Received
    May 24, 2013
    Date of Event
    April 25, 2005
    Report Date
    May 2, 2013
    Manufacturer
    COVIDIEN, FORMERLY TISSUE
    Product Code
    FTL
    PMA / PMN Number
    K992556
    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: STRESS UI/PELVIC ORGAN PROLAPSE. 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
    231884 PELVICOL 4 X 12 CM PELVICOL MESH FTL COVIDIEN, FORMERLY TISSUE 04B14-2

    Patients

    Seq Age Sex Outcome Treatment
    1 65 YR Female Other