BEUDAMED
    FDA Adverse Event Injury Summary report: N

    PELVICOL ACELLULAR COLLIGEN MATRIX

    MDR report key: 3143159 · Received May 24, 2013

    Report

    Report Number
    9617613-2013-00296
    Event Type
    Injury
    Date Received
    May 24, 2013
    Date of Event
    February 8, 2006
    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

    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
    231074 PELVICOL ACELLULAR COLLIGEN MATRIX PELVICOL MESH FTL COVIDIEN, FORMERLY TISSUE 04B06-2

    Patients

    Seq Age Sex Outcome Treatment
    1 30 YR Other PELVISOFT, 481068, 6X8CM/1.0MM, LOT # 05B21-9| EXP. 06/30/2008