BEUDAMED
    FDA Adverse Event Injury Summary report: N

    PELVICOL 4 X 12 CM

    MDR report key: 3232230 · Received July 8, 2013

    Report

    Report Number
    9617613-2013-00478
    Event Type
    Injury
    Date Received
    July 8, 2013
    Date of Event
    November 6, 2008
    Report Date
    June 12, 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

    TRACKING NUMBER (B)(4). COVIDIEN IS SUBMITTING THIS REPORT ON BEHALF OF (B)(4). (IMPORTER).

    Description of Event or Problem · 1

    PROCEDURE: STRESS UI/ PELVIC ORGAN PROLAPSE. 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
    308720 PELVICOL 4 X 12 CM PELVICOL MESH FTL COVIDIEN, FORMERLY TISSUE 07B01

    Patients

    Seq Age Sex Outcome Treatment
    1 21 YR Other